Total Hours/Month and Shift Length

[Doc Brown]

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So does anybody know how PD's (or whoever) come up with how many hours residents should work a month when in the ED? Unlike the rest of the medical world, even the most slavish ED programs doesn't come close to the 80 hour week or have the mentality that being on call q 1 is the only way of learning medicine. It seems, then, that the amount of hours worked is rather arbitrary. It doesn't seem to be related to patient census or the amount of residents/year (actually, I don't know if any of this is true. Just my humble opinion from the interview trail).

IMHO, shifts should not be longer than 10 hours. After 10 hours, learning drops to zero and productivity falls with it. I've personally noticed softer admits and consults as hour 12 approaches.

The mentality seems to be, though, that if you decrease shift length, you automatically have to increase number of shifts worked. It is as if the total number of hours worked was pre ordained by God (or maybe it is... that's why I'm asking).

Bottom line: Residency is a time to get your ass kicked. I just feel that there are better and more productive ways of kicking said ass.

 

[FoughtFyr]

So does anybody know how PD's (or whoever) come up with how many hours residents should work a month when in the ED? Unlike the rest of the medical world, even the most slavish ED programs doesn't come close to the 80 hour week or have the mentality that being on call q 1 is the only way of learning medicine. It seems, then, that the amount of hours worked is rather arbitrary. It doesn't seem to be related to patient census or the amount of residents/year (actually, I don't know if any of this is true. Just my humble opinion from the interview trail).

IMHO, shifts should not be longer than 10 hours. After 10 hours, learning drops to zero and productivity falls with it. I've personally noticed softer admits and consults as hour 12 approaches.

The mentality seems to be, though, that if you decrease shift length, you automatically have to increase number of shifts worked. It is as if the total number of hours worked was pre ordained by God (or maybe it is... that's why I'm asking).

Bottom line: Residency is a time to get your ass kicked. I just feel that there are better and more productive ways of kicking said ass.

As I understand it (and please correct me if I am wrong), the EM RRC has much more restrictive rules than does the ACGME. They are:
1. Maximum 12 hour scheduled shift (may stay later as needed, but only to facilitate handoff, not take new patients).
2. No more than 60 clinical hours in one week.
3. An average of at least one full 24 hour period without any duties (clinical or educational) every seven days.
4. A minimum of 10 hours, or the length of the precedant shift, which ever is greater, between shifts.

These rules only apply to EM shifts. Off service rotations fall under the ACGME rules (80 hour work week, etc.).

- H

 

[BKN]

As I understand it (and please correct me if I am wrong), the EM RRC has much more restrictive rules than does the ACGME. They are:
1. Maximum 12 hour scheduled shift (may stay later as needed, but only to facilitate handoff, not take new patients).
2. No more than 60 clinical hours in one week.
3. An average of at least one full 24 hour period without any duties (clinical or educational) every seven days.
4. A minimum of 10 hours, or the length of the precedant shift, which ever is greater, between shifts.

These rules only apply to EM shifts. Off service rotations fall under the ACGME rules (80 hour work week, etc.).

- H

Right, also no more than 72 hrs total scheduled duties in a week for ED rotations. Off service rotations have the same rules as the other specialties.

Here's a suggestion. Before you go on the interview trail, actually read the program requirements from the RRC. That way you can judge whether the program is delivering what you need. Try http://www.acgme.org/acWebsite/downloads/RRC_progReq/110pr905.pdf

 

[beyond all hope]

It is pretty arbitrary. Most EM residencies work 40-55 clinical hours/week in the ED. There is a minimum set by the RRC (I think 36-40) and a max already
outlined. EM residencies are probably the most humane clinical residencies that exist. Much better than medicine or surgery.

Also don't forget hours are not everything. Also volume, ancillary staff, ease of consults/admissions are all factors in how hard your day actually is. A 12 hour shift at some cush ED is easier than an 8 hour shift at a really hopping ED. Also, if you work with fun people the hours fly by. If you work with people you don't like you'll be watching the seconds tick away.

Yes, clinical acumen gets softer at the end of the shift. This is true for every specialty. Especially after an overnight. We're all vulnerable to exhaustion.

You have to see a buttload of patients with a variety of presentations during your residency so you leave feeling competant. Don't make the mistake of trying to do a cush residency. You'll regret it in the end.

 

[FoughtFyr]

Here's a suggestion. Before you go on the interview trail, actually read the program requirements from the RRC. That way you can judge whether the program is delivering what you need. Try http://www.acgme.org/acWebsite/downloads/RRC_progReq/110pr905.pdf

Thanks for the reference, but I graduate in June and I suspect that my next employer will not be bound by the RRC (unless I get that Tox fellowship I'm eyeing).

- H

 

[Apollyon]

Thanks for the reference, but I graduate in June and I suspect that my next employer will not be bound by the RRC (unless I get that Tox fellowship I'm eyeing).

- H

I don't think he was talking to you.

 

[BKN]

Thanks for the reference, but I graduate in June and I suspect that my next employer will not be bound by the RRC (unless I get that Tox fellowship I'm eyeing).

- H

Right, I was referring to the OP.

 

[GeneralVeers]

Hours and number of shifts don't necessarily mean anything.

My program has one of the "easiest" schedules, with 12 hours shifts in a 2-on, 2-off sequence for 15 shifts per month. However those 12 hours I'm on I am worked to death, and when I go home I crash hard. I need those 2 days off just so I can go back to work again somewhat refreshed.

 

[docB]

So does anybody know how PD's (or whoever) come up with how many hours residents should work a month when in the ED?

Malice mostly. But don't forget evil.

 

[FoughtFyr]

Right, I was referring to the OP.

I know... I should've hit after I wrote it.

- H

 

[FoughtFyr]

I know... I should've hit after I wrote it.

- H

So let me do it now...



- H

 

[Doc Brown]

It is pretty arbitrary. Most EM residencies work 40-55 clinical hours/week in the ED. There is a minimum set by the RRC (I think 36-40) and a max already
outlined. EM residencies are probably the most humane clinical residencies that exist. Much better than medicine or surgery.

Also don't forget hours are not everything. Also volume, ancillary staff, ease of consults/admissions are all factors in how hard your day actually is. A 12 hour shift at some cush ED is easier than an 8 hour shift at a really hopping ED. Also, if you work with fun people the hours fly by. If you work with people you don't like you'll be watching the seconds tick away.

Yes, clinical acumen gets softer at the end of the shift. This is true for every specialty. Especially after an overnight. We're all vulnerable to exhaustion.

You have to see a buttload of patients with a variety of presentations during your residency so you leave feeling competant. Don't make the mistake of trying to do a cush residency. You'll regret it in the end.

So what I was trying to find out is how the program director determines whether it will be 40 or 60 hours? Unlike other specialities, it does seem to be a decision (versus, I suppose, work them until someone writes the ACGME). Does it have to do with patient census? Does it have to do with a certain pre-determined number of patients a resident needs to see before residency ends (closer to that famous 30,000-60,000 marker)? Does it have to do with the number of residents/year? Does it have to do with the number of off service rotations that residents do? Does it have to do with the number of off service residents rotating through the ED?

The reason I ask is not to get a cushy residency program (I'm already a resident), but rather that I have friends in programs that work a lot more than I do, and other friends that work a lot less. And there doesn't seem to be an apparent reason why (at least in terms of patient census or acuity of patients).

P.S.- I also don't like 12 hour shifts.