Advertisement - Members don't see this ad
You only get 4 days off a month, ****. Medicine blows.
-
CycleTrack and SDN are teaming up to make medical school admissions more transparent and accessible! Read the announcement to learn how we’re supporting the future of CycleTrack’s free application-tracking tools .
Time: "medical residents worked too hard"
Started by eyang22286
Get help with your application
Use all the free resources available to you from SDN: articles, guides, expert advising, forums discussions, and school research.
You only get 4 days off a month, ****. Medicine blows.
Do we get Sundays off? I'm guessing no.
why sunday? you can't buy alcohol, stores close early and everyone is sleeping/getting ready for the week.👎
Advertisement - Members don't see this ad
I don't know, to watch NFL I guess.
can't buy alcohol? sure you can
For some reason, when it comes to training, medicine stops being evidence based. The basic standard of the medical profession is that the minimum amount of training that we need is the maximum amount of training that has ever been considered necessary (which is the only reason those residencies are considering going from 3 to 4 years, BTW, there's no study justifying that decision). All of the various studies that show no difference in outcomes for lower levels of training vs higher levels (FP docs vs EM docs in the ER having similiar outcomes, NPs having similar outcomes to FPs in primary care, etc) are disregarded on the basis of a nebulous 'feeling' that you won't be good enough unless you learn more. The exact kind of emotionally charged unscientific crap that even premeds scoff at when it comes from Pharm companies or CAM practicioners is suddenly irrefutable truth when it has to do with residency training. After all "I talked to this guy in Europe, and he totally felt like this works better".
Now there's probably a reasonable debate about just how much of a change in patient outcomes is worth forcing an extra year of training on everyone, but before we even have that debate first I need to see at least some evidence that more training is improve outcomes AT ALL.
Once again, third world factory workers go on strike when they're told to work 30 hour shifts. And they don't feel the need to justify it by saying 'please sir, if I could just sleep a bit I could make a much a better widget'. It's perfectly alright to say that we should have limits on our shifts for the plain and simple reason that we have the right to sleep at night. Nurses, military pilots, Marine recruits, fraternity pledges, and war criminals have all secured contractual/legal protection against sleep deprevation and, if we had the slightest sense, we would insist on at least that same bare minimum standard of treatment.
Last edited:
Yeah, this is pretty important to me. Otherwise I'm gonna be watching TV in my patients' room ALL the time, or checking my phone constantly. I'm a professional slacker, i'll get it done somehow.
not where i live👎
How do you know this? I doubt you can comprehend how much experience/time you'll need to learn to practice medicine. There is a reason why x residency is 5 years instead of 4 years: it takes time to learn what is being taught.
If you can learn something in 60 hours and not 80, then why not 40 hours instead of 60 or 20 hours instead of 40? Where is the line drawn?!
Why not cut all residencies down to 3 years? It seems like I'd be able to learn anything if I put in 60 hours for 3 years......
In a q4 call system, you generally get 4 days off a month. They aren't always scheduled the way you want -- the goal is to have people take off non-call or post-call days, and not all take off the same day. Many places (especially for the med students) try to work it so the days off are on weekends, so you get two weekends where you have 1 day off, one weekend where you have both days off (a golden weekend) and one weekend when you have no days off (a black weekend). But other places don't stick with the weekend plan, and you will see one intern off on a Tuesday, and the next one gets off a Friday one week, and another two weekdays the next week, and neither gets a weekend day off..Don't plan on a lifestyle as a resident that is similar with what you are used to now.
You're probably right.
And you keep this up for 5, 6, even 7 years? ****in brutal. How much vacation time do you get?
Advertisement - Members don't see this ad
usually 2-4 weeks per year, depends on the program
Is it the same for all specialties? Which would offer me more free time during residency?
I don't mind suffering to get what i want, but if there's a less rigorous path that still gets me where I want to go, i'd much rather do that.
The number of weeks vacation is the same across all specialties at each particular hospital. (In the same way that the PGY salaries are the same across all specialties at each hospital.)
So picking a specialty based on the amount of vacation during residency probably wont' help you. However, as you apply for residency you should check because you could try and match at a hospital that offers 4 weeks instead of 2, which adds up over the course of four years.
The amount of vacation is about the same across specialties, but the rigor is definitely different as you advance to later years in certain specialties. Surgeons stay about as intense throughout the first bunch of years. Some of the ROAD specialties are less intense after the internship year. Everyone else is in the middle. Bear in mind that in some fields (esp non-surgical), you will have weeks or months here and there where you are doing less intense "rotations" (with less call), or even may have elective time where if you do something less intense like, say, research or rheumatology, or rads, you may be working very civilized hours for the week/month. (Although a lot of folks will use this lighter schedule to also moonlight and put some $ in their pockets). But over the bulk of the year you will probably be doing q4 in most fields (q3 in some surgical things, perhaps q5 in other fields/places). Expect to have 3-4 weeks off each year spread out as the coordinator sees fit after getting your request, plus the 4 days off per month, and maybe a lighter or elective month or two (in non-surgical fields). That's life as a resident. It's why it's rough. It's also how you learn a lot because you are always there. The whole reason these folks got the name resident was because at one time they "resided" in the hospital. (You can still find some hospitals that still have the attached dorms).
I recommend picking a field you enjoy without focusing too much on the residency hours. The 3-5 or so years of residency will be a pain, but not nearly the pain of spending 40+ years in a field you don't enjoy. So if it's an uphill climb to get there, you just suck it up and do it. Lifestyle can be a factor in the ultimate field, but it's short-sighted to make it a deal breaker for the residency years.
Just as a slight addendum, some fields and some hospitals have implemented "night float." Which is in lieu of q4 call... Some people love it and would choose it over q4 any day, where as some hate night float and would rather do q4.
It seems the people who prefer q4 like having most of the day off "post-call." So when they leave the hospital post call between 10AM and Noon, they get the rest of the day off, and they don't like adjusting to sleeping during the day for the weeks on night float. The people who prefer night float seem to be able to adjust, but consider that day "post call" a waste since you are too tired to actually do anything useful.
Still, based on your personal preferences regarding the above, something to consider.
Agreed -- night float exists at a lot of places, particularly in IM, but it's a hot debate as to whether it helps or hurts, with the majority of residents probably feeling that the grass is greener. Night float doesn't eliminate all call BTW -- at most places you still have "call" every 4th day, but you are technically allowed to leave after 9pm (or whenever night float comes on) every 4th day (but rarely get out on time, and may actually be there until 11-12 finishing up loose details or trying to stabilize patients before you hand them off, only to return by 6 the next day for post-call pre-rounding). For most people, if you are often going to be there until 11+, and have to be in for a full twelve hour day starting at 6 the next day, and have any sort of commute, you are much much much better off doing the overnight and getting out by noon the next day. If you are lucky, you get an hour or two of sleep during your overnight shift and don't end up wasting the whole day.
And even with night float, you still generally have overnight call on weekends if your fourth day falls on those days -- night float is generally a weekday thing at most of the places I've seen. I'm sure some places do it differently, but the night float systems I'm familiar with all work as above.
It's very interesting reading pre-med debates on medical residency. Your outspokenness on these matters will decrease gradually until 3rd year, at which point you will truly see how little you know about medical training and education.
The matter of residency training, in light of the current advances in therapy, cost-effective health care and public sentiment about about our field is far more complicated than anyone on this forum (including myself) realizes. Considering that the overwhelming majority of you have never spent a single night on call, having this discussion is basically pointless. But since pointless discussion is a favorite indulgence of the anonymous internet, I'll add my thoughts.
One of the main things no one has mentioned, again because no one has taken call, is what do we housestaff actually do during that 30-40 hour shift. The intern may still be admitting patients - doing a crappy physical exam and taking a history (or copying the poor history done by the ER resident.) If she is not still admitting patients, then she's got a buttload of instructions for patients who have been signed out to her by the interns who are not on call - mainly following up on lab tests and x-rays. Then she's getting constant pages from the floor nurses taking care of these patients because Mr. Smith has a fever, or Mrs. Jimenez has a headache or some other patient fell out of bed. None of this requires the brain power of string-theory or astrophysics.
The thing is, a hospital needs a couple interns to take care of this stuff, but not a whole army. This is why call sucks - 3/4 of it is menial tasks, the rest is actual (read: interesting) work: i.e. difficult management decisions, challenging diagnostic work-ups. Most of the learning comes from the evaluation and management of new patients, not babysitting patients lounging around in the hospital receiving IV antibiotics. In many hospitals, interns only get new patients on call. If you decrease the call, you decrease all parts of it, including the part where the real training occurs.
Second, advances in medical treatments has changed the number of available, more complex cases because they occur less often. The most classic example is coronary bypass surgery. Better pharmacological treatments and non-invasive cardiology procedures have decreased the number of necessary surgeries. That means that the cardiothoracic surgeons may finish their fellowships with 150 instead of 400 surgeries (my made up numbers). The only way to graduate trainees with equal volumes is to extend the training.
Another example, closer to my field, and less high end, is appendectomy. When I did my surgical rotation, I was taught that appendicitis was a clinical diagnosis. If the surgeon thought the patient had a surgical abdomen based on the physical exam and lab values, the patient went to the OR. A 15% false-positive rate was expected. If it was lower, then it was assumed that the surgeon was missing some of the more subtle cases. These days, the surgical resident won't step foot into the ER to see the patient until after I've read the abdominal CT. No doubt that's better for those false positives who would have gone under the knife or the laparoscope, but that's still fewer surgeries for the residents. Potential solution? Longer training.
Personally, I don't yet have an opinion on the work restrictions, mainly because I realize how complicated the picture actually is. I worked about 110 hours/wk during my inpatient months as a medical intern. I probably only worked more than 80 hrs/wk a couple times as a radiology resident. But I will say that a 13 hour night float shift as a radiology resident was much more fatiguing than a 36 hour shift as a medical intern.
'Cause someone is bound to ask, my worse rotation was OB. I was there from 4:30am until 7pm - unless I was on call, when I'd leave at 7pm the next day. On a call shift, I'd see the ancillary staff come to work, go home, come back to work, and go home again before I left. Also, it was winter, so the only sunlight I saw during that period was whatever peeped through a patient's room. I have vivid memories of sulking back to my car, slightly annoyed the by smell of blood and placenta which somehow had gotten into my seat and my apartment. Ah, the good old days...
The matter of residency training, in light of the current advances in therapy, cost-effective health care and public sentiment about about our field is far more complicated than anyone on this forum (including myself) realizes. Considering that the overwhelming majority of you have never spent a single night on call, having this discussion is basically pointless. But since pointless discussion is a favorite indulgence of the anonymous internet, I'll add my thoughts.
One of the main things no one has mentioned, again because no one has taken call, is what do we housestaff actually do during that 30-40 hour shift. The intern may still be admitting patients - doing a crappy physical exam and taking a history (or copying the poor history done by the ER resident.) If she is not still admitting patients, then she's got a buttload of instructions for patients who have been signed out to her by the interns who are not on call - mainly following up on lab tests and x-rays. Then she's getting constant pages from the floor nurses taking care of these patients because Mr. Smith has a fever, or Mrs. Jimenez has a headache or some other patient fell out of bed. None of this requires the brain power of string-theory or astrophysics.
The thing is, a hospital needs a couple interns to take care of this stuff, but not a whole army. This is why call sucks - 3/4 of it is menial tasks, the rest is actual (read: interesting) work: i.e. difficult management decisions, challenging diagnostic work-ups. Most of the learning comes from the evaluation and management of new patients, not babysitting patients lounging around in the hospital receiving IV antibiotics. In many hospitals, interns only get new patients on call. If you decrease the call, you decrease all parts of it, including the part where the real training occurs.
Second, advances in medical treatments has changed the number of available, more complex cases because they occur less often. The most classic example is coronary bypass surgery. Better pharmacological treatments and non-invasive cardiology procedures have decreased the number of necessary surgeries. That means that the cardiothoracic surgeons may finish their fellowships with 150 instead of 400 surgeries (my made up numbers). The only way to graduate trainees with equal volumes is to extend the training.
Another example, closer to my field, and less high end, is appendectomy. When I did my surgical rotation, I was taught that appendicitis was a clinical diagnosis. If the surgeon thought the patient had a surgical abdomen based on the physical exam and lab values, the patient went to the OR. A 15% false-positive rate was expected. If it was lower, then it was assumed that the surgeon was missing some of the more subtle cases. These days, the surgical resident won't step foot into the ER to see the patient until after I've read the abdominal CT. No doubt that's better for those false positives who would have gone under the knife or the laparoscope, but that's still fewer surgeries for the residents. Potential solution? Longer training.
Personally, I don't yet have an opinion on the work restrictions, mainly because I realize how complicated the picture actually is. I worked about 110 hours/wk during my inpatient months as a medical intern. I probably only worked more than 80 hrs/wk a couple times as a radiology resident. But I will say that a 13 hour night float shift as a radiology resident was much more fatiguing than a 36 hour shift as a medical intern.
'Cause someone is bound to ask, my worse rotation was OB. I was there from 4:30am until 7pm - unless I was on call, when I'd leave at 7pm the next day. On a call shift, I'd see the ancillary staff come to work, go home, come back to work, and go home again before I left. Also, it was winter, so the only sunlight I saw during that period was whatever peeped through a patient's room. I have vivid memories of sulking back to my car, slightly annoyed the by smell of blood and placenta which somehow had gotten into my seat and my apartment. Ah, the good old days...
Interesting thread. I don't yet have an established opinion, b/c I'm just getting ready to start from square one. But, I appreciate the above post.
I have noticed a trend on SDN, however. You'll notice that the most outraged about residency hours are pre-meds and some med students. That tapers off a little in the medical school forums. And, in the specialty forums for residents there may be someone here or there raving that physicians are pushovers and that call is sleep deprivation/torture. But, most of the residents that post argue the other side.
So, it appears that we pre-meds may likely change our minds on this and many other issues when we see what experts we weren't.
I have noticed a trend on SDN, however. You'll notice that the most outraged about residency hours are pre-meds and some med students. That tapers off a little in the medical school forums. And, in the specialty forums for residents there may be someone here or there raving that physicians are pushovers and that call is sleep deprivation/torture. But, most of the residents that post argue the other side.
So, it appears that we pre-meds may likely change our minds on this and many other issues when we see what experts we weren't.
just hold it man, you will be able to go once a week...buy a plunger and some colace for your time on the throne.
it will be the highlight of your week.
WTF. Medicine is so damn bizarre.
Dermatology residents only work 45.1 hours per week on average?!?!
And they get paid $45,613 per year!?!?!
And they get 1.8 days off per week? That's 90% of a legitimate weekend!
I found this info here
http://www0.ama-assn.org/vapp/freida/spcindx/0,,TR,00.html
Is this true? Can anyone confirm reports of residents in certain specialties working more humane hours and earning living wages?
And they get paid $45,613 per year!?!?!
And they get 1.8 days off per week? That's 90% of a legitimate weekend!
I found this info here
http://www0.ama-assn.org/vapp/freida/spcindx/0,,TR,00.html
Is this true? Can anyone confirm reports of residents in certain specialties working more humane hours and earning living wages?
"Stanford derm is like a country club." --Stanford derm resident (true quotation)
Not really. Here's how it works, without getting in to population statistics, sensitivity and specificity:
Let's take a population of people with acute appendicitis. Most of them with have a certain number of objective or subjective signs and symptoms consistent with the disease. Then, too, some of them will have few if any of those signs and symptoms. To catch as many of the real appendicitis cases as possible, the surgeons have to set a somewhat low diagnostic threshold - so as to not miss those less obvious cases, knowing that there are gonna be some people that get opened up with normal appendices.
If a surgeon were to say ,"Every person I've taken to the OR for an appendectomy really had appendicitis," looking at the nature of the disease, it would be assumed that the surgeon wasn't operating on enough patients. Nobody's clinical acumen is that good.
My point in the prior post was that abdominal CT has affected general surgery training in several ways. One, the surgeons don't rely as strongly on their clinical diagnostic skills. A huge amount of medical training comes from "making the call." CT isn't perfect and I occasionally have to tell the surgeon that I'm not sure. But most of the time I can accurately see a normal or abnormal appendix - thus preventing the surgeon from having to "make the call." A lot of old-school surgeons complain that the younger ones rely too much on imaging. But old docs always complain about the younger ones... Of course, there are myriad other decisions that surgeons make in and out of the OR completely unrelated to imaging.
Secondly, and the point of my other post, there are skills to be gained from doing a surgery and post-surgical management, even from a 15-20 minute operation like an appendectomy. Every borderline, equivocal clinical evaluation that I call as an unremarkable CT, or renal stones, or inflammatory bowel disease is a case where the surgical resident is not cutting (and the med student retracting).
Now if this process is extrapolated to other organ systems and diseases, then we can see how advances in imaging and non-surgical therapy are slowly diminished surgical volume.
Caveat to potential future surgeons: you'll still have a buttload of OR cases - shooter's abscesses in IV druggies, members of the knife and gun club, car accidents, gastric bypasses, tumors and whatnot to keep you on-call every third or fourth night for 5-7 years during your late 20's-30's. Enjoy.
Most university programs pay residents based on post-graduate year (pgy), regardless of specialty. At UCLA, a 4th year neurosurgery resident (pgy-4), got paid the same as a 3rd year radiology resident (pgy-4), and the same as an infectious disease fellow (pgy-4). This may have changed, but I doubt it.
In radiology residency, we didn't work weekends unless we were on call. There's no weekend rounding - unless you're talking about a round of golf or a round of drinks.
4
45408
Yeah, but if you start at 5-6am, the 16 hour rule kicks in at 9-10pm, and your 5 hour nap ends at 2-3am. I don't know about you guys, but that's not when I need to sleep. When I was on OB, we started at 5:30am, and our call shifts ended around 7:30am the next day. About half the time, you didn't even see the call room. I'm still a machine at 9pm, and I'm ready to die at 3am. I'd prefer a required "midnight to 5am" nap or something, rather than a 16 hour rule.
Advertisement - Members don't see this ad
What, pray tell, are you talking about? The 3 year residencies - FP, Medicine, Peds, Psych, and EM - are all still 3 years with no plans to 'increase' them to 4 years. The only situation I can see being remotely tied to your statement is with EM. Some EM programs are 4 years and were initially designed that way, to incorporate a research heavy year. But seriously, "many of the 3 year residencies"?
Your statement is patently false and has no fact behind it. Sorry.
I'm not saying it's 100% reasonable. If we're going for our comfort I think we should be on 12 hour max shifts like nurses and pilots. It's WAY better than a 30 hour shift, though. I've put in plenty of 16 hour days before medical school started. 30 hours, though, is insane.
What he's talking about is the fact that attendings/hospital administrators like to threaten docs with the possibility of longer residencies when they try to demand things like sick days and the chance to go home and sleep at night. Which since doctors have failed to fight for decent residcency pay in addition to not fighting for decent hours is horrifying enough to shut most people up. Your right, though. Work hour rules have come and gone and I haven't seen a wave of residencies making good on their threat to lengthen their training.
Last edited:
