What does q3 with an 80 hr workweek mean?

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So, I'm thinking about surgery, but the call schedules are on my mind, and I'd appreciate any thoughts that the SDN community might have.

It seems that most programs out there have q3 call for the intern and PGY-2 years. While q3 call seems pretty brutal (as a MS3, we had q8!), a classmate of mine mentioned that if there's adherence to the 80 hr workweek, q3 wouldn't be that bad.

The hours would be something like this:
Monday (call night): 6 AM to Midnight (18 hrs)
Tuesday (post-call): Midnight to Noon (12 hrs)
Wednesday: 6 AM to 6 PM (12 hrs)
Thursday (call night): 6 AM to Midnight (18 hrs)
Friday (post-call): Midnight to Noon (12 hrs)
Saturday: 6 AM to 4 PM (8 hrs)
Sunday: Off

Is this accurate? I actually think this schedule is viable. It's staying until 8 PM on your post-call and swing days that seems untenable (not to mention a detriment to patient care).

 

[Amy]

I think you're wrong in saying most interns work q3. q4 is the standard.

 

[SocialistMD]

Q3 looks something like that. There are a few rotations at my school's program that are q3, and they typically go home around 5 on pre-call days and have to be out by 1 on post-call days. The residents not on call over the weekend typically manage to get out by noon on the weekend days because they are only there to round on their patients (and maybe pick up a lap chole while they are there). Still, I have to agree with Amy in that q4 is probably the norm now rather than q3.

 

[Ergo]

also q4 here for interns.

 

[Bovie9]

a lot of programs have night float, too. We take call on friday (24), saturday (24), or sunday (only until 5:30p), with night float coverage all other times. We usually take call appx. 3 times/month, with night float 2 months out of the year.

 

[Foxxy Cleopatra]

We have several rotations that are q3 in-house call through chief year. Though most programs are aware that there may be serious consequences if the "rule" is broken, working 24 or 30 continuous hours is still within compliance and happens frequently.

I admit that I love taking the post-call nap as much as the next person, but as I have advanced in residency and gained more responsiblity, I've found that really taking care of patients and being responsible for things doesn't fit perfectly in the guidelines of the 80 hour rule. Many people (PD's, attendings, residents) feel that way so I would not be surprised if there are amends to the 80-hour rule in the years to come.

My point is, how would you feel about surgery if the 80-hour rule were to change or the day when you finish that you are on call Fri-Monday for your group and crap hits the fan non-stop all weekend? If you would have serious reservations about entering surgery if 80 hours didn't exist, think long and hard before signing up or you will resent it. I'm not saying that it makes one a bad person if they don't want to work as hard as people did in the olden days but the responsiblity of surgery and what it takes to learn and be good at it requires an enormous amount from a person. Nonetheless, I love being able to be the one who can really fix things and would choose it again if I had to do it over.

 

[njbmd]

Hi there,
With my program, we take overnight call on Friday and Saturdays. This means that we start at 5:45 AM on Friday night and go through 8:00AM on Saturday or whenever you finish weekend rounding for your service. The latest that you may work is 12 noon if you started at 5:45AM. On Saturday, you work through 8:00AM on Sunday or until you are done with rounding on your service. Your cross cover duties end at 8:00AM but you may have things to do on your service. The night float team works from 6pm to 6am M-Thr and from 8AM Sunday through 6AM on Monday for a 22-hour shift. They are off from 6AM Friday to 8AM Sunday.

You have to cover either a Friday or a Saturday shift twice a month. You may have one Friday or one Saturday or two Fridays or two Saturday shifts. It just depends on where you come in the cycle of call. If you are not night float, you are expected to be in the hospital from 5:45AM to 6PM. If your service is not busy, your chief may send you home early to read. Most of the interns come in way under 80-hours but the senior residents skirt very close to 80 and go over one or two weeks and get time off the next week to average 80.

You work harder in the hours that you are in the hosptal because the night float people are out of the day schedule so less people to do the same amount of work. On the other hand, after 6pm, there are less people covering more patients so the night float people are very, very busy. The key to a good night float system is making sure that there is good sign out and that the day folks get as much done as possible. You have to anticipate what your patient might need and provide it or warn the night float person so that they can provide it. Good sign-outs are essential for the night float person too because they will often admit and work up folks in the middle of the night and hand them off in the morning. Everyone has to be very vigilant about getting to work on time and keeping up.

The 80-hour work week has been difficult for surgery but with good people, it can be accomplished. Just be prepared to work very, very hard in exchange for more time at home.

nbjmd 🙂