Who is working these 80-100 hrs/week?

[droliver]

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I was thinking about this today. Who exactly are the hordes of residents actually working this many hours a week? I assume my training (about to start my PGY-5 year) is typical of many surgical residencies. My first few years I was probably in the hospital certain rotations for 100-110 hours/week if you include inhouse call. Most of my services @ this point are now much less time in the hospital with more 24/7 beeper call at home with a few services maybe approaching 80-90 hrs.

Looking at the other residents I work with in other specialties, I know they don't work more than I do with the exception of maybe the thoracic fellows or PGY 2/3 neurosurgeon. ER residents only work ~ 12-14 days a month (and then many moonlight another 6-10 days).
Medicine & the medicine fellows have somewhat irregular schedules, but they don't routinely (if ever) work 80-100 hrs/week. Then you have my friends in path,PMR,ENT,anesthesia, neurology, family practice, ortho, & opthomology & I know none of them punch in anywhere approaching 80 hrs in a normal week (especially as upper levels).

Which again begs the question for me.... Are these much-malighned 100 hr work weeks oft talked about, but rarely realized outside surgery services? I tend to think so, at least based on my observations from school & during my training at a large university-based tertiary care center.

Are there any upper level residents out there who would chime in on this with your experiences @ other programs?

 

[Whisker Barrel Cortex]

My sister is finishing her OB/GYN residency and she has worked many 80-100 hour weeks and a couple of 120 hour weeks. Other than OB/GYN, general surgery, neurosurgery, and possibly ortho, I don't think many specialties have those kind of hours regularly. However, the medicine and peds residents that I worked with did work up to 100 hours / week when on ward months. Usually around 80-90. The interns have these hours for 9 months, 2nd year residents 6 months, and 3rd year 4 months. So its not all the time but they DO have these hours for part of the year.

I think that med and peds schedules are more dependent on the program than in OB and surgery, so there are many easier programs out there.

 

[droliver]

How much of that 120 hrs in a week was sleeping at night while her students wrote notes on her l&D patients Q2 hours(sorry- having horrible L&D flashbacks there). 😀

Seriously, I just don't believe the #'s people put out there for a lot of these things. I think your perspective will change after you finish medical school & hit the trenches. With
most places limiting or eliminating Q2 call, cursory appearances by upper level residents during their in house call, & night float systems for medicine/peds & OBGYN at many programs, a lot of the thunder from these "100 hr. weeks" loses some credibility. That being said, having just finished 2 months of 16 hr weekdays + 15 hrs on the weekend ( "only" 90 real hours/week + 24/7 beeper call for my inhouse junior residents problems/?), I am tired enough.

 

[Sevo]

•••quote:•••Originally posted by droliver:
•How much of that 120 hrs in a week was sleeping at night while her students wrote notes on her l&D patients Q2 hours(sorry- having horrible L&D flashbacks there). 😀 •••••We weren't allowed to even do that at the hospital that I (unfortunately) had to my OB rotation at.

Essentially, call was sitting/sleeping in front of the L&D board until you were called to retract for that crash C-section.

Thanks to the L&D nurses, patients were often reminded of their OPTION to have a medical student around. As predicted, more often than not they opted NOT to have us near them.

Hmm... Didn't seem to be a problem when a resident demanded that someone had to be there to retract legs when those post-delivery vaginal tears needed to be repaired.

Whoa! Too many bad clerkship memories...

Back to the topic at hand, most of the residents that I met, outside of the general surgical residents, usually worked 60-80 hour weeks.

 

[dbiddy808]

I'd say that very few specialties or programs work these types of hours. Maybe surgery interns or residents on a trauma/sicu service, but few others. From what I've seen, for some reason people like to exagerate about how many hours they work. Most residents, on most rotations work far less that 80 hours per week. For internal medicine, I'd say that very few programs even approach 80 hours per week. If they do, it is probably only ICU rotations for 3-4 months out of three years. From what I've seen, most radiology residents and ER residents work 40-50 hours per week.

 

[Hopkins2010]

part of the problem here is that a lot of hospitals mask the number of hours their residents work so you cant get an accurate picture.

there should be some sort of mandated, standardized reporting scheme that requires all hospitals to clock their residents in and out and report their numbers.

then perhaps we can get a better idea and maybe find out that its not as bad as we thought. But this 'veil of mystery' that hospitals like to have around work hours NEEDS TO GO. Its time for upright honesty and full disclosure. I think our patients deserve at least that much.

 

[Winged Scapula]

It is true that interns and junior residents here are still working those hours and more - dependent on luck of the draw and the number of juniors on service (ie, if you have 3 people splitting writing the notes on pre-rounds you can come in later than if its just yourself - the rotations vary widely with regard to number of housestaff on; there are no "rules" by rotation. Just luck. Luck also plays a role in the amount of trauma - when I did it last summer we had 3 times the numbers of patients that we did when I did it in March of this year again.)

However, I would guess the senior levels, with the exception of the 4th years, do work less hours. They don't come in as early as we do, if not operating, are able to take time off for personal errands (ie, getting hair cut) and they take home call. Juniors here only have 1 month of home call during the first 2 years - at the VA. It spoiled me! :wink: Our 4th years are tortured and work extremely long hours - they are responsible for all General Surgery Consults, ER hits, etc. Again, for all seniors the hours varies with regard to rotation; on CT the 3rd years take solo in house-call (ie, no fellow backup) and then spend all day the following in the OR, not leaving until rounds are done the following evening - from 36-48 hrs later.

Interesting to read about other senior's schedules. There does seem to be a bit of machismo involved in exaggerating one's work hours - highly interesting to me droliver, because that was one of my concerns/complaints about your program - I felt like the residents on Trauma (when I was there doing Plastics) highly exaggerated their hours and complained incessantly about it! :wink:

 

[Winged Scapula]

•••quote:•••Originally posted by baylor21:
•part of the problem here is that a lot of hospitals mask the number of hours their residents work so you cant get an accurate picture.
•••••Exactly. Many hospitals get around the RRC guidelines by doing things like not including beeper call, or required conferences, journal club, subtracting an hour a day for lunch and 30 minutes for "breaks" "rolleyes" etc. into the total hours worked.

 

[droliver]

kimberli,

Now our trauma service really has been b/w 105-120 hrs. a week in the hospital depending on whether you had the 3 or 4 days of the week on call. Starting July 1 we go to Q3 with the general elective service covering the other shift which should put the hrs closer 80-90 week. For the record, this change is not popular with a lot of the residents because you get into some continuity of care concerns & you drag out your in house trauma over more months (I'll do 5 months Q3 instead of 3 months Q2). Personally, I hated Q2 call in house- its very hard on the juniors (not as much on the chiefs b/c you tend no to get bothered with 80%+ of stuff during the night) and I think it is a good change.

Actually Kimbeli, kind of following some of your posts this past year it sounds like your Penn St. program is much more flagrant with some of the kind of work hour related isues then you seemed to feel it was here. We don't have any more Q2 call, the PGY 1/2's regularly get 2 full weekend days off a month, on a lot of services the post call interns get sent home before noon (I don't ever keep anyone other than the on-call person if we have to make evening rounds, & usually I can do it faster by myself & not even bother them except to check out to) , and a # of services our 3-5 years have no or little call

 

[Winged Scapula]

•••quote:•••Originally posted by droliver:
•kimberli,

Now our trauma service really has been b/w 105-120 hrs. a week in the hospital depending on whether you had the 3 or 4 days of the week on call. Starting July 1 we go to Q3 with the general elective service covering the other shift which should put the hrs closer 80-90 week. For the record, this change is not popular with a lot of the residents because you get into some continuity of care concerns & you drag out your in house trauma over more months (I'll do 5 months Q3 instead of 3 months Q2). Personally, I hated Q2 call in house- its very hard on the juniors (not as much on the chiefs b/c you tend no to get bothered with 80%+ of stuff during the night) and I think it is a good change.

Actually Kimbeli, kind of following some of your posts this past year it sounds like your Penn St. program is much more flagrant with some of the kind of work hour related isues then you seemed to feel it was here. We don't have any more Q2 call, the PGY 1/2's regularly get 2 full weekend days off a month, on a lot of services the post call interns get sent home before noon (I don't ever keep anyone other than the on-call person if we have to make evening rounds, & usually I can do it faster by myself & not even bother them except to check out to) , and a # of services our 3-5 years have no or little call•••••RIO...

Sounds as if some positive changes are afoot at UofL. You are right - long works hours have been a major problem here. Suprisingly, they are BETTER than they used to be if you believe the stories the seniors tell (Chief: "when I was an intern we worked 184 hours a week." Me:"But there aren't 184 hours IN a week, sir!" :wink: ).

We still have a long way to go however. Only on CT are interns allowed to go home post-call and ONLY if there is another intern to cover for them. All other services generally require you to be here until evening rounds are finished - and often that may be late if the Chief is in the OR or Traumas are coming in. We generally get the ONE full weekend off a month, EXCEPT on CT which puts you on call the Friday night of that weekend (so you end up sleeping most of Saturday away because you've been up all night writing the SICU notes before rounds). Call is generally q3, with 3 months of q4-5 (cross cover) but then there are weeks of q2 as well if someone is on vacation. Next year we have 2 extra PGY 2s - it will be interesting to see if there are changes which reflect the increased manpower here.

I agree - things here could be much better, yet they could also be much worse. We're making strides...just slowly!

 

[Goofy]

Dr Oliver said:

•••quote:•••Seriously, I just don't believe the #'s people put out there for a lot of these things. I think your perspective will change after you finish medical school & hit the trenches. ••••I believe the numbers. Further, one doesn't have to complete medical school to appreciate the rigors and time demands of residency. As 3rd year students, many of us worked along side the resident including night call. Certainly as subinterns this was the case.

 

[droliver]

Klebsiella,

you may feel like you have an understanding of the life during residency, but your perspective completely changes on this side of the fence. As a student you really can't appreciate the pacing & ebb/flow of the busiers residencies. There are some things you overestimate how difficult they will be, and there are some things you underestimate (especially free time, kind of like the transition from undergrad to med school). This same change in perspective also occurs as you progress during your residency. All in all, my residency has been easier than what I imagined it would be like after my 3rd/4th year rotations (nothing could have been as bad as what I was imagining)

 

[TheThroat]

I keep a fairly regular tab of the hours I work as a surgery intern at UIowa:

VA General Surgery, q3 in house call: about 90 hours/week, one weekend off/mo
Vascular Surgery, q2 home call: about 70 hrs/wk, two weekends off/mo
Trauma surg, q3 in house call: app. 90 hrs/wk, one weekend off/mo
CT surg (what I am on now), q3 in house: about 100 hours/week.

I do other months on Urology (q5 home call, 3 weekends off/mo!!), pedi surg (q2 home call, 2 wkend off/mo, home by 4-5 pm often), and G-surg (q6! in house call, 2 wkends off/mo).

Oh, and by the way, I don't consider my job hard work. I love this stuff. Seriously, I can't imagine getting paid three times what I am being paid now to do something like be an accountant or a lawyer or an investor. I am living the life I want to live, have incredible job security, have an AMAZING financial future, and get free health care (good for those with families).

 

[Voxel]

Remind me to keep a log of my radiology residency hours. Now that would make for some interesting conversation. :wink:

 

[Winged Scapula]

•••quote:•••Originally posted by Voxel:
•Remind me to keep a log of my radiology residency hours. Now that would make for some interesting conversation. :wink: •••••Even more interesting by way of comparison would be to have Great Pumpkin keep track of his Pathology residency hours! Which reminds me - haven't seen him in awhile. Guess that q7 call is getting to him!! :wink:

 

[GreatPumpkin]

Hah Q7 no way. And, no 80 to 100 hour weeks either. 🙂

Avg about 50 hours a week on easy rotaions and 70ish on tougher ones. And, on surg path I have to work half days every 3rd Sat.

 

[Winged Scapula]

•••quote:•••Originally posted by GreatPumpkin:
•... on surg path I have to work half days every 3rd Sat.•••••Oh the horror of it all! :wink:

BTW, what are you doing up at this hour? Me, I'm handling drunks in the Trauma Bay. YOU should be sleeping my friend (or getting TOO much of it these days? Tee hee)

 

[ApacheIndian]

•••quote:•••Originally posted by Voxel:
•Remind me to keep a log of my radiology residency hours. Now that would make for some interesting conversation. :wink: •••••Would you say that Rads residencies are the cushiest of all? Possibly tied for that honor with Path or Psych? What do you think?

 

[Whisker Barrel Cortex]

I think path residencies overall are the cushiest (plus they don't have to do a clinical internship year). Radiology is still pretty light when compared to most other specialties, but has seen an increase in hours over the past 10 years. More and more CTs and MRIs are being done with no increase in residents. Also, many of the smaller rads programs have q4 call for at least the first two years of residency because they have less residents in the call pool (watch out for places that have 2 residents on call per night, this cuts the pool in half). Also, I've heard radiology call can be one of the busiest and most stressful call nights because many clinical decision will be made on your call with no attending back-up. Even with all that, its much nicer than most other specialties.

 

[Voxel]

I've been overnight call at a busy academic medical center with 2 radiology residents on call one junior and one senior and it was still hell trying to finish all the studies by the morning. They got no sleep all night but granted they were on night float, so that made their lives a little easier. All types of surgical residents breathing down their necks to make quick decisions so they could operate or dump to medicine. And don't get me started on ER requests for film interpretation. They are never happy no matter how fast you do things. 🙂

Radiology call is pretty brutal compared to pathology or psychiatry. I cannot imagine being up for 24+ hours alone doing all that was required of them. It'll be me in a few. LOL. I'll be sure to log my hours (on call and how much sleep I could get) and let you guys know. The only saving grace is that at my program we are out post call by 10ish in the morning. And call is like q6, q8, q10, q12 (years 1-4).

 

[ApacheIndian]

Hey Voxel, > or = to q6 call doesn't sound too bad. If I understood correctly, even if you are up and busy all night, you do get to go home by 10am the next day and it's [at it's most frequent] q6? Is that right? What about a typical non-call day... what's that look like? I would kill to be in your and WCB's shoes right now... congrats.

 

[Whisker Barrel Cortex]

Typical non-call days from what I have seen at my school depends on the rotation. Everyone starts at 7:30 with conference until 8:30. Neuro MR and Body CT are pretty busy with occasional quiet times and stay until 6-7pm most of the time. Neuro CT, chest, bone, abdominal (GI/GU) are usually lighter and out of there by 5pm. Interventional usually anywhere from 5-8pm depending on the caseload. The interventional day has some down time between cases.

These are just what I saw at school. My residency and other residencies are probably gonna have some variability. Good luck Dr_Cuts!

 

[GreatPumpkin]

Yea, Pathology is definetly sweet. At MCV we certainly have the best hours. I am sure it may vary some from place to place.

The neurosurgery folks seem to have it the worst here. The chief told us he averaged 115 hours a week. No thank you.

 

[Neurogirl]

My program is pretty good...70-80 hrs per week (avg one call per week), with a fair amount of down time during the day (depending on the rotation), but the calls are pretty tough. I rarely get to sleep more than 2-3 hrs. and often get no sleep. Next year things will get much better...50-60 hrs per week with home call. 😀

I think most of the 100-120 hr weeks come from interns, surgical specialties and the more malignant medicine programs. For example, I know of one east coast medicine program that is nothing short of a slave labor camp! The residents routinely work 120 hr weeks, with NO down time. A typical "lunch hour" is 5 min. spent inhaling a sandwich, and they rarely get more than a nap during calls. When one person complained to the PD about the hours, they were told, "Well, you know you really don't HAVE to work that many hours, but I can certainly see how it happens. You're such a good doctor...people like you always end up spending extra time with patients and going the extra mile...GOOD JOB."!!!!! Now is that smooth or what! All but 2 of the 45 interns and residents are FMGs...not surprising. That's how they get away with it! The program knows that these residents have no where else to go. 😡