Weekly hours that interns work

[Code Brown]

OK, so I was flipping through the Jan 13th, 2005 NEJM and here is what I found:

Weekly hours that interns worked during 2002-2003:

40 hours or less = ~9%
41-60 hours = ~18%
61-80 hours = ~26%
81-100 hours = ~33%
101-120 hours = ~11% (excessive?)
121-140 hours = ~2% (these people are nuts!)
140+ hours = ~0.25% (no comment)

Longest work shift in the past month:

16 hours or less = ~24%
17-20 hours = ~4%
21-24 hours = ~3%
25-28 hours = ~6%
29-32 hours = ~18%
33-36 hours = ~31%
37-40 hours = ~10%
41-50 hours = ~2%
51+ hours = ~0.25%

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[AnotherDork]

Actually, the strangest part of those statistics is that 1 out of 11 interns is working less than 40 hours per week. How is that possible? Am I overlooking something? Can I get THAT job, please?

 

[Writer1985]

Weekly hours that interns worked during 2002-2003:

40 hours or less = ~9%
41-60 hours = ~18%
61-80 hours = ~26%
81-100 hours = ~33%
101-120 hours = ~11% (excessive?)
121-140 hours = ~2% (these people are nuts!)
140+ hours = ~0.25% (no comment)

It worries me that nearly half the interns are working more than the legal limit of 80 hours/week. Don't want to get into <i>those</i> programs!

 

[Blade28]

This is data from 2002-2003, though...was the new 80-hour workweek in effect yet (at all programs)? Who was surveyed? from which residency types?

 

[Sparky Man]

It worries me that nearly half the interns are working more than the legal limit of 80 hours/week. Don't want to get into <i>those</i> programs!

I know what you mean. But on the other hand, I have heard some residents complain that it really interrupts the care of their patients. Some would much rather follow the case all the way rather than just bail because they reached the 80 hour limit.

 

[Ross434]

I know what you mean. But on the other hand, I have heard some residents complain that it really interrupts the care of their patients. Some would much rather follow the case all the way rather than just bail because they reached the 80 hour limit.

Yeah, i agree with this. It really hurts learning when you have to leave in the middle of a case, especially when it comes to surgery. Thats why so many programs fudge their numbers.

 

[Blake]

Not anything new. Yup, people work a lot in medicine. You'd better not be in it for money, that's for sure, cause you won't spend entire week-ends playing golf and driving your Ferrari.

 

[powermd]

Yeah, i agree with this. It really hurts learning when you have to leave in the middle of a case, especially when it comes to surgery. Thats why so many programs fudge their numbers.

You raise an interesting point- but I don't think anyone walks out on a surgical case in progress to keep an individual day's hours down. I never saw it as a third year med student, but I could be completely wrong, because I've been doing medicine for the past year. Now, as for the hour limit hurting continuity of care on the medical floors- bull$hit. What hurts continuity of care is that doctors are human beings and need to sleep at some point and have some kind of life, perhaps if just to remember why they care enough to spend 80-hours per week in the hospital. Now if we were all robots who could work 24/7 without rest, that would be ideal, right? Enough time is spent doing BS tasks during the day that 80 hours ought to be enough. Hire PAs, NPs or whatever to make resident's time better spent. NYU neurosurgery does this- midlevels cover the floors, do discharges, etc. Eventually we all need to sign out to another doctor. Does it really matter if this occurs within an 80-hr/wk framework vs 120-hrs/wk?

 

[Code Brown]

You raise an interesting point- but I don't think anyone walks out on a surgical case in progress to keep an individual day's hours down. I never saw it as a third year med student, but I could be completely wrong, because I've been doing medicine for the past year. Now, as for the hour limit hurting continuity of care on the medical floors- bull$hit. What hurts continuity of care is that doctors are human beings and need to sleep at some point and have some kind of life, perhaps if just to remember why they care enough to spend 80-hours per week in the hospital. Now if we were all robots who could work 24/7 without rest, that would be ideal, right? Enough time is spent doing BS tasks during the day that 80 hours ought to be enough. Hire PAs, NPs or whatever to make resident's time better spent. NYU neurosurgery does this- midlevels cover the floors, do discharges, etc. Eventually we all need to sign out to another doctor. Does it really matter if this occurs within an 80-hr/wk framework vs 120-hrs/wk?

Since you are going through this, from what you've both experienced and seen firsthand, is the fact that residents work 80+ hours based on the fact that:

1. hospitals make residents work that hard/long or
2. residents want to work that hard/long to learn on their own

 

[Iwy Em Hotep]

It worries me that nearly half the interns are working more than the legal limit of 80 hours/week. Don't want to get into <i>those</i> programs!

Correct me if I'm wrong, but I think that the rule is that interns can work no more than an average of 80 hours per week over a two week period. So yeah, it's very likely that interns work more than 80 hours any given week.

 

[powermd]

Since you are going through this, from what you've both experienced and seen firsthand, is the fact that residents work 80+ hours based on the fact that:

1. hospitals make residents work that hard/long or
2. residents want to work that hard/long to learn on their own

Are you kidding? I have NEVER met an intern colleague in IM who has wanted to stay in the hospital any longer than necessary on a given day. The department tells us what our schedules are, we really don't have a choice but to work the hours they set for us. The chairman of our department (who's an amazing doctor, and very compassionate person) has stated we are used as cheap labor. On floors we have a night float who covers patients overnight, and a PGY-2 float who admits overnight so the call teams can go home by 11pm. This keeps floor hours a reasonable 65 hours per week. In the units we average about 80/wk.

 

[8744]

I know for a fact that the surgery department here is very, very scrupulous about the 80 hour requirement. As the 80 hours are averaged over four weeks, it is possible that a resident can work more than 80 hours in any given week but he will have to work fewer hours on other weeks.

Several programs around the country are on probation for violating the ACGME rules about work hours.

But, shoot, we're still talking about 80 hours here, folks. That is still a lot of time to spend at any job. If you can't get trained in five years of 80 hour weeks then I suggest that your department is not using your training hours efficiently. How well are you really paying attention to anything after staying awake for two days in the middle of a 120 hour work-week?

I'm doing the Emergency Medicine match. EM programs work nothing like the hours of Surgery and medicine. In fact, except when you are off service (like for a Medicine rotation) most EM programs work 16 to 18 12 hour shifts per month with five hours of conference per week (at least it was like that everywhere I interviewed). Other than the fact that you might be working night shifts, this is not a bad kind of schedule.

And, except when on an off-service rotation, there is no, repeat no call. None. Nada. Zippo.

THe key is to find a program where your off service rotations are minimized. All of the programs I ranked at the top of my list had only six or seven total months of off-service rotations in the entire three year program.

I hate call. I hate rounding. I hate hanging around the hospital tying up loose ends or just waiting to be cut loose. At least in EM you have a recognizable "shift change" at a set hour at which time you have a brief "check out" and you are on the way back to the crib.

 

[8744]

Are you kidding? I have NEVER met an intern colleague in IM who has wanted to stay in the hospital any longer than necessary on a given day. The department tells us what our schedules are, we really don't have a choice but to work the hours they set for us. The chairman of our department (who's an amazing doctor, and very compassionate person) has stated we are used as cheap labor. On floors we have a night float who covers patients overnight, and a PGY-2 float who admits overnight so the call teams can go home by 11pm. This keeps floor hours a reasonable 65 hours per week. In the units we average about 80/wk.

Har har. Too true. Early in medical school I learned to vanish as soon as my Chief Resident said I could go. In fact, I was probably 100 feet way and several floors down before the "m" on "Go home" was fully formed.

The key is to put a lot of structure between you and your service if you are cut loose. As a medical student, this prevents them from calling you back for some last minute task.

I always hated the gunners who, on being cut loose, would ask some variation of the "are you sure there's nothing more we can do" question.

Good Lord. If you offer yourself up as a sacrificial animal you will be slaughtered.

 

[dopaminophile]

The funny thing is that the 80 week came into existance because people felt that tired interns made more mistakes and patients were being hurt as a result of the errors. In actuality, more errors result from poor information exchange at shift changes and when they cut intern hours, there were more shift changes, which resulted in an increase in the error rate and even more dead patients. Bummer.

 

[dmoney41]

In actuality, more errors result from poor information exchange at shift changes and when they cut intern hours, there were more shift changes, which resulted in an increase in the error rate and even more dead patients.

Reference?

 

[dopaminophile]

Reference?

I got it from "Internal Bleeding" ca 2004 by Robert M. Wachter, M.D. and Kaveh G. Shojania, M.D. and from "Intern Blues" by Robert Marion, M.D. I don't know where the origional studies came from. "Internal Bleeding" is an excellent, very current discussion of medical errors if anybody's interested. "Intern Blues" is a diary of three peds interns in the '80s edited by Marion. He talked about inters' hours in the updated epilogue.

 

[powermd]

The funny thing is that the 80 week came into existance because people felt that tired interns made more mistakes and patients were being hurt as a result of the errors. In actuality, more errors result from poor information exchange at shift changes and when they cut intern hours, there were more shift changes, which resulted in an increase in the error rate and even more dead patients. Bummer.

The reality is that people do become fatigued, and do need to go home at some point. That necessitates the process of signing out responsibility for one's patients to another doctor. If done well- the doctor signing out identifies the important issues with his patients and provides specific instructions on how to deal with expected problems, there shouldn't be much of a change in qualtiy of care. I guarantee you a doctor who has been working 36 hours straight does a worse job signing out his patients than a doctor just finishing a 24 hour call.

If you believe the shift changes that occur within an 80-hour week are to blame for medical errors, than how do you propose we fix the system? Is longer hours with fewer shift changes the solution?

 

[dopaminophile]

The reality is that people do become fatigued, and do need to go home at some point. That necessitates the process of signing out responsibility for one's patients to another doctor. If done well- the doctor signing out identifies the important issues with his patients and provides specific instructions on how to deal with expected problems, there shouldn't be much of a change in qualtiy of care. I guarantee you a doctor who has been working 36 hours straight does a worse job signing out his patients than a doctor just finishing a 24 hour call.

If you believe the shift changes that occur within an 80-hour week are to blame for medical errors, than how do you propose we fix the system? Is longer hours with fewer shift changes the solution?

I'm not suggesting that I have a better idea. I'm just pointing out the fluctuations in error rates as these different systems are tried out. The fact is, hospitals experienced more harmful, avoidable mistakes when house staff hours were cut. The most reasonable explanation is that miscommunications occur at shift changes. Shift changes and transfers have previously been identified as the major problem areas for errors in medical care. Perhaps well integrated computer systems will help remedy that issue. I don't claim to be an expert... just an observer.