What are ophtho residency hours like?

[rocketbooster]

What are your residency hours like? Do you usually meet the 80 hr/week limit for all residencies? Do you ever go over, like frequently in general surgery and ortho?

Residents in most specialties seem to have 12 hour shifts each day. 6am-6pm or 6-pm-6am. These specialties have a lot of inpatient, though, so it makes sense to need residents at the hospital at all times. How are ophtho shifts set up for residents? It seems like a waste to make a resident be there all night when there are not many in-patients, not to mention few emergencies that couldn't wait til the morning. Obviously you would need someone to be on call every night, but can it usually be taken from home?

How much OR time and clinic time do you get during the week? When do you usually make rounds in the hospital? I could see ophtho residents not needing to get there at 6am unlike most other residencies. What are your hours like? When do you get there and get home? Do you get the standard 1-day off per week like most residents? How often do you take call?

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[ophthope]

What are your residency hours like? Do you usually meet the 80 hr/week limit for all residencies? Do you ever go over, like frequently in general surgery and ortho?

Residents in most specialties seem to have 12 hour shifts each day. 6am-6pm or 6-pm-6am. These specialties have a lot of inpatient, though, so it makes sense to need residents at the hospital at all times. How are ophtho shifts set up for residents? It seems like a waste to make a resident be there all night when there are not many in-patients, not to mention few emergencies that couldn't wait til the morning. Obviously you would need someone to be on call every night, but can it usually be taken from home?

How much OR time and clinic time do you get during the week? When do you usually make rounds in the hospital? I could see ophtho residents not needing to get there at 6am unlike most other residencies. What are your hours like? When do you get there and get home? Do you get the standard 1-day off per week like most residents? How often do you take call?

Hours vary pretty seriously by program. Only one place where I interviewed gave me hard numbers - they were a top program and said they worked an average of 55 hours/wk and 16% of weeks were over 60 hours. Keep in mind this does not include all those hours on call, though. ALMOST all residency programs have call taken at home, but a few have a dedicated Eye Emergencies Room and take in-house call so their hours get a lot closer to the 80 hour limit. I still haven't heard any horror stories of going over 80 except for maybe some fluke week. Call schedules very from q4week to q3day. If you take call for a whole week at a time your call is pretty light, because if it was moderate to heavy you'd be dead after a week of it. Some places do call over the whole weekend Fri night-Mon morn but others split up the days of the weekend. If they're splitting up weekend days, weekends are probably heavier than at other places. There is very little inpatient in Ophthalmology but a pretty heavy amount of consult is normal. So expect to have a full day of clinic 8-4/5 but then if you haven't been able to squeeze in seeing your consults during the day you'll have to do that before leaving (when you're on consult, of course). It varies how consult is handled. At some places you're just on consult 2 months straight during your first year, other plays it's qSomething, like call. Don't underestimate how busy you can get on call, though. Out in the private world Ophthalmologists never go in, but I have come to understand that this is because they send all those patients to a referral center with a residency program. You work pretty hard on call in residency by seeing all those entrapped muscle floor fractures and open globe injuries that the private Ophthalmologists send out. Which, honestly is good for our training but adds to the workload. You don't want to get out in practice not having done enough open globe repairs that you feel uncomfortable.

Many programs start their days at 6:30 or 7:00 with lectures. At my home institution three days a week are lectures at 7:00 or so, and the other two vary depending what you are doing that day. Clinic starts around 8:30 and OR time usually begins at 7:00. As for days off it's usually more than the standard 1 day off per week. Freida from the AMA has training statistics for each specialty and they say the average is 1.6 days off per week (compared gen surg at 1.1 and medicine at 1.2).

 

[rocketbooster]

Hours vary pretty seriously by program. Only one place where I interviewed gave me hard numbers - they were a top program and said they worked an average of 55 hours/wk and 16% of weeks were over 60 hours. Keep in mind this does not include all those hours on call, though. ALMOST all residency programs have call taken at home, but a few have a dedicated Eye Emergencies Room and take in-house call so their hours get a lot closer to the 80 hour limit. I still haven't heard any horror stories of going over 80 except for maybe some fluke week. Call schedules very from q4week to q3day. If you take call for a whole week at a time your call is pretty light, because if it was moderate to heavy you'd be dead after a week of it. Some places do call over the whole weekend Fri night-Mon morn but others split up the days of the weekend. If they're splitting up weekend days, weekends are probably heavier than at other places. There is very little inpatient in Ophthalmology but a pretty heavy amount of consult is normal. So expect to have a full day of clinic 8-4/5 but then if you haven't been able to squeeze in seeing your consults during the day you'll have to do that before leaving (when you're on consult, of course). It varies how consult is handled. At some places you're just on consult 2 months straight during your first year, other plays it's qSomething, like call. Don't underestimate how busy you can get on call, though. Out in the private world Ophthalmologists never go in, but I have come to understand that this is because they send all those patients to a referral center with a residency program. You work pretty hard on call in residency by seeing all those entrapped muscle floor fractures and open globe injuries that the private Ophthalmologists send out. Which, honestly is good for our training but adds to the workload. You don't want to get out in practice not having done enough open globe repairs that you feel uncomfortable.

Many programs start their days at 6:30 or 7:00 with lectures. At my home institution three days a week are lectures at 7:00 or so, and the other two vary depending what you are doing that day. Clinic starts around 8:30 and OR time usually begins at 7:00. As for days off it's usually more than the standard 1 day off per week. Freida from the AMA has training statistics for each specialty and they say the average is 1.6 days off per week (compared gen surg at 1.1 and medicine at 1.2).

Thanks for the info. Haha Freida says 51.8 hours per week average for residents. Gen surg is 75. Ouch.

Any current residents want to share?

 

[Dusn]

Home call at a major academic hospital (usually a trauma center) means that you will often be working much of the night and not have it count towards your duty hours. It's hard to sleep with a pager going off constantly and depending on how far you live from the hospital, you'll often save time by just sleeping at the hospital. You will be working the next day as well.

The reason that there are more consults than most non-ophthalmologists realize is because consults will mostly come from the ER. And often can go straight from the ER triage nurse directly to you. The ER doctor might not even see the patient and will just wait for you to bring back your consult report. Depending on your program, you may be taking call at multiple hospitals simultaneously. Overnight and on weekends, you will not be with a team; you will be seeing patients on your own or with a backup senior resident that you can call. If you're at a large tertiary care center, you will have patients transfered in to see you from every ER in your state and the surrounding states. Many of the ophthalmology practices in the surrounding area will have their answering machine tell their patients to call you after hours for any problems that they may have.

Unless you're in a cush program where you basically shadow the attendings and see their private patients like a medstudent, the hours will probably be worse than what you've seen in general medicine. The programs that provide you with more experience will generally have worse hours. It's hard to quantify exactly but working 80 hours a week as a medicine intern was easier than my first year of ophtho.

 

[rocketbooster]

Home call at a major academic hospital (usually a trauma center) means that you will often be working much of the night and not have it count towards your duty hours. It's hard to sleep with a pager going off constantly and depending on how far you live from the hospital, you'll often save time by just sleeping at the hospital. You will be working the next day as well.

The reason that there are more consults than most non-ophthalmologists realize is because consults will mostly come from the ER. And often can go straight from the ER triage nurse directly to you. The ER doctor might not even see the patient and will just wait for you to bring back your consult report. Depending on your program, you may be taking call at multiple hospitals simultaneously. Overnight and on weekends, you will not be with a team; you will be seeing patients on your own or with a backup senior resident that you can call. If you're at a large tertiary care center, you will have patients transfered in to see you from every ER in your state and the surrounding states. Many of the ophthalmology practices in the surrounding area will have their answering machine tell their patients to call you after hours for any problems that they may have.

Unless you're in a cush program where you basically shadow the attendings and see their private patients like a medstudent, the hours will probably be worse than what you've seen in general medicine. The programs that provide you with more experience will generally have worse hours. It's hard to quantify exactly but working 80 hours a week as a medicine intern was easier than my first year of ophtho.

Ah I see. Where does the 51.8 hr average come from? Doesn't include consults? Why wouldn't they include the consults?

But also wouldn't that only be when you're on call? How often is call?

 

[guttata]

Home call at a major academic hospital (usually a trauma center) means that you will often be working much of the night and not have it count towards your duty hours. It's hard to sleep with a pager going off constantly and depending on how far you live from the hospital, you'll often save time by just sleeping at the hospital. You will be working the next day as well........

Many of the ophthalmology practices in the surrounding area will have their answering machine tell their patients to call you after hours for any problems that they may have.
.

This is crazy, are you sure? None of the private practices do that where I practice now (and there are a lot of ophthalmologists in town). I also did not hear about it during training. Are those practice affiliated with the hospital or residency program?

How do they get away with it? If I were the on-call attending (at the academic center), I would refuse to see those patients.

 

[blesss]

Home call at a major academic hospital (usually a trauma center) means that you will often be working much of the night and not have it count towards your duty hours. It's hard to sleep with a pager going off constantly and depending on how far you live from the hospital, you'll often save time by just sleeping at the hospital. You will be working the next day as well.

The reason that there are more consults than most non-ophthalmologists realize is because consults will mostly come from the ER. And often can go straight from the ER triage nurse directly to you. The ER doctor might not even see the patient and will just wait for you to bring back your consult report. Depending on your program, you may be taking call at multiple hospitals simultaneously. Overnight and on weekends, you will not be with a team; you will be seeing patients on your own or with a backup senior resident that you can call. If you're at a large tertiary care center, you will have patients transfered in to see you from every ER in your state and the surrounding states. Many of the ophthalmology practices in the surrounding area will have their answering machine tell their patients to call you after hours for any problems that they may have.

Unless you're in a cush program where you basically shadow the attendings and see their private patients like a medstudent, the hours will probably be worse than what you've seen in general medicine. The programs that provide you with more experience will generally have worse hours. It's hard to quantify exactly but working 80 hours a week as a medicine intern was easier than my first year of ophtho.

MFW pager ... O_O

Genuinely curious here, are those still used?

 

[Slide]

This is crazy, are you sure? None of the private practices do that where I practice now (and there are a lot of ophthalmologists in town). I also did not hear about it during training. Are those practice affiliated with the hospital or residency program?

How do they get away with it? If I were the on-call attending (at the academic center), I would refuse to see those patients.

Most of the practices in my state will either have their answering machine tell patients to go to the ER for urgent issues, or if they're on phone call, if it's not a problem that can be taken care of quickly the next workday in clinic, they are automatically sent to the ER. To be fair, this seems to be more common for the optometry practices than ophthalmology practices.

What makes it worse is that we can't refuse any consults made from the ER. If it's from a private patient from a different private practice, we still have to see them. Having these patients also follow up with us instead of their regular provider for further care is considered "bad practice" as well despite bailing them out. Our teaching center, despite its advances and improvements, is still considered a dumping ground for practices after-hours. I agree, it's ridiculous sometimes.

 

[Slide]

Hours vary pretty seriously by program. Only one place where I interviewed gave me hard numbers - they were a top program and said they worked an average of 55 hours/wk and 16% of weeks were over 60 hours. Keep in mind this does not include all those hours on call, though. ALMOST all residency programs have call taken at home, but a few have a dedicated Eye Emergencies Room and take in-house call so their hours get a lot closer to the 80 hour limit. I still haven't heard any horror stories of going over 80 except for maybe some fluke week. Call schedules very from q4week to q3day. If you take call for a whole week at a time your call is pretty light, because if it was moderate to heavy you'd be dead after a week of it. Some places do call over the whole weekend Fri night-Mon morn but others split up the days of the weekend. If they're splitting up weekend days, weekends are probably heavier than at other places. There is very little inpatient in Ophthalmology but a pretty heavy amount of consult is normal. So expect to have a full day of clinic 8-4/5 but then if you haven't been able to squeeze in seeing your consults during the day you'll have to do that before leaving (when you're on consult, of course). It varies how consult is handled. At some places you're just on consult 2 months straight during your first year, other plays it's qSomething, like call. Don't underestimate how busy you can get on call, though. Out in the private world Ophthalmologists never go in, but I have come to understand that this is because they send all those patients to a referral center with a residency program. You work pretty hard on call in residency by seeing all those entrapped muscle floor fractures and open globe injuries that the private Ophthalmologists send out. Which, honestly is good for our training but adds to the workload. You don't want to get out in practice not having done enough open globe repairs that you feel uncomfortable.

Many programs start their days at 6:30 or 7:00 with lectures. At my home institution three days a week are lectures at 7:00 or so, and the other two vary depending what you are doing that day. Clinic starts around 8:30 and OR time usually begins at 7:00. As for days off it's usually more than the standard 1 day off per week. Freida from the AMA has training statistics for each specialty and they say the average is 1.6 days off per week (compared gen surg at 1.1 and medicine at 1.2).

My hours as a PGY-2 are pretty similar to what you stated. Taking first call in residency is a thrill at first, but it loses its luster fast. After the second month, most consults are bullcrap and are of little educational value; there's nothing to learn after seeing your 100th orbital wall fracture, or another corneal abrasion. Hell, out of all the orbital wall fractures I've seen, I've only had one patient that urgently required repair of an orbital wall fracture for an entrapped rectus muscle. Really, the main reason why call is so tough despite the fewer hours worked is that 1) you have little support on call (no nurses to help, ER residents/attendings are useless, everyone refuses to look at an eye, etc.), 2) consults have to be seen fairly quickly, and 3) even if you work a busy night, you still have to work the next day in clinic or in the OR. Luckily, it gets better with each year (at least here it does).

 

[Hemichordate]

I'm curious, when you first start taking call as a first year resident (with little knowledge about ophthalmology), do you have more senior residents guide you while you're doing consults, or are you already doing everything yourself from day 1?

 

[Dusn]

This is crazy, are you sure? None of the private practices do that where I practice now (and there are a lot of ophthalmologists in town). I also did not hear about it during training. Are those practice affiliated with the hospital or residency program?

How do they get away with it? If I were the on-call attending (at the academic center), I would refuse to see those patients.

You're right, I said that incorrectly. The attendings who worked directly with us may have their patients page us directly for any problems. Many of the surrounding ophthalmologists or optoms who never worked with us would have their answering machines say: "if you have an eye emergency that cannot wait until the following business day, please go directly to (academic center) ER."

(To be fair, the better ophtho practices I knew did not do this and I never got a post-op call from someone we didn't work directly with. So I think the ophthalmologists at least would have a way for their post-ops to get through to them).

Outside patients, however, would figure out how to call our hospital operator and get put through to our pager regardless of whether they had ever been seen in our clinic. All of the surrounding ER physicians would also page us to ask questions as well, and I'd tell them to just transfer the patient (no matter how benign sounding the exam) because I wasn't going to give advice over the phone regarding a patient I had never seen to someone who may not know a thing about the eye. To make a long story short and give advice to those thinking about ophtho: it's a cool field but I don't think it's easy.

 

[rocketbooster]

You're right, I said that incorrectly. The attendings who worked directly with us may have their patients page us directly for any problems. Many of the surrounding ophthalmologists or optoms who never worked with us would have their answering machines say: "if you have an eye emergency that cannot wait until the following business day, please go directly to (academic center) ER."

(To be fair, the better ophtho practices I knew did not do this and I never got a post-op call from someone we didn't work directly with. So I think the ophthalmologists at least would have a way for their post-ops to get through to them).

Outside patients, however, would figure out how to call our hospital operator and get put through to our pager regardless of whether they had ever been seen in our clinic. All of the surrounding ER physicians would also page us to ask questions as well, and I'd tell them to just transfer the patient (no matter how benign sounding the exam) because I wasn't going to give advice over the phone regarding a patient I had never seen to someone who may not know a thing about the eye. To make a long story short and give advice to those thinking about ophtho: it's a cool field but I don't think it's easy.

Idk man sounds a lot easier than gen surg. Those residents tell me they dont record over 80 but probably average 90

 

[Dusn]

Gen surg? Of course, ophtho is much easier.

I'm not comparing ophtho to those fields that you have to be masochistic to go into (ob-gyn, gen surg, neuro-surg) and I'm not trying to create some sort of pissing contest about who works harder. I'm saying that the reputation of ophtho being easy is blown out of proportion when compared to the majority of physician specialties.

 

[sven]

Programs vary a lot, but yes ophthalmology hours are on average much better than gen surg or comparable specialties.

At my program, we take in house call and are very busy during it. The plus side is that we have a night float system so you have only one 24ish hour day per week and the rest are 12-14 hour shifts. There's very little going to clinic fatigued from being up the night prior.

That being said, our first years can definitely hit 80 hours a week at times. Things get much better as you get more efficient, though. You might work 7 to 9:30 at the beginning of the year, but rarely stay after 7 towards the end. The program is also front heavy so 2nd year is much more chill before responsibilities pick up again 3rd year.

Its a mistake to get too caught up with hours as the measurement of a program or specialty. If you love what you're doing you'll be happy. Particularly early on, you won't/shouldn't want to leave because the learning curve is so steep and there's a lot of novelty. My days as an intern sucked a lot more even when they were shorter; ophtho is much, much more fun than running around with a bunch of check boxes for bowel regimens, heparin drips, getting called every time someone has a tiny run of afib, etc.

 

[sven]

Oh, and starting call. It sounds much more scary than it is. Most programs ease you in with "buddy call" or some equivalent. Nobody expects you to be able to evaluate the retina before you can see it. For the first 6 weeks (including 2 weeks of orientation) we were paired with a 3rd year to show us the ropes. Basically, the 3rd years have a huge incentive to help you out - the better they teach you early in the year, the less often they hear from you during the night later on. Senior residents do (or should) remember that they also didn't know anything not to long ago.