Why do Doctors work so many hours

[EastSide]

Just out of curiosity, why do Doctors work so many hours/week?
I've heard some say in the next decade we will experience a shortage of doctors. If this is the case, I understand.
But some say that the field is becoming over-saturated.
Is it simply that some doctors work more hours to make more $$$, or do some doctors just enjoy working 80hours.

If hospitals hire 1 or 2 more doctors in order to distribute the amount of hours that needs to be covered, Doctor can work 40-50 hours rather than 60-80 hours.

Same applies for residencies. If the program opens up their seat for a couple more residents, the hours can potentially dwindle down from a 100 hour weekly schedule to at LEAST 60 hours a week. Can some argue that this intensive training is to strengthen one's stamina?
But what's the point if, upon completion, they won't work 100 hours/week. Also, I feel that by cutting hours, residents can better absorb their training, and be less prone to burn out before starting out their careers.

Thanks your time!

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[VA Hopeful Dr]

Sigh

Agreed, but I'll take a stab at it anyway as my next 2 patients rescheduled...

First, because people get sick 24/7/365. You always need a certain amount of doctors available no matter the time.

Second, if you take the work of one doctor and cut it in half then you also get paid half as much.

Residencies have to be paid for. Adding more residencies nowadays means the hospital has to shell out extra money. Plus, you have to see whether or not there is sufficient patient volume to justify adding residents.

 

[AcademicNeurosurgery]

Two reasons: money and patient outcomes.

Many medical errors happen during handoffs (shift changes). Since we are terrible at communication, the solution has been to decrease shift changes rather than educate people on how to communicate more effectively. 2 12-hour shifts compared to 3 8-hour shifts means one less chance for information to be lost/misinterpreted/forgotten.

Second reason is money. Hospitals are not going to hire more doctors to decrease the load because the hospital will make less profit. If four neurosurgeons are covering a hospital and put up with the hours, there's no incentive to hire a fifth. And if one of them decides they don't want to work those hours, the hospital can bump the salary up a bit and reel in someone else who is willing to put in the hours.

With regards to oversaturation, not all specialties are the same. Certain specialties in big cities are over saturated simply because everyone wants to live there. The shortage is for areas where people don't want to live and specialties people don't want to go into. With most specialties, you won't have a hard time finding a job if you are flexible.

It's just not that easy to hire physicians and decrease work load.

 

[Light at end of tunnel]

Dude, real doctors work 168 hours per week.

 

[AcademicNeurosurgery]

Dude, real doctors work 168 hours per week.

Why 168? Such an odd number to stop working at, I don't stop until I hit 180-200/week.

 

[Light at end of tunnel]

Why 168? Such an odd number to stop working at, I don't stop until I hit 180-200/week.

Simple really, anything over 168 and they have to pay you over time.

 

[mhagerman]

Why 168? Such an odd number to stop working at, I don't stop until I hit 180-200/week.

Amateurs. A real doctor would willingly enter themselves into a Groundhog Day-type scenario, during which they can work a never-ending number of 24-hour shifts, thereby accumulating an infinite number of hours per theoretical week.

 

[AcademicNeurosurgery]

Amateurs. A real doctor would willingly enter themselves into a Groundhog Day-type scenario, during which they can work a never-ending number of 24-hour shifts, thereby accumulating an infinite number of hours per theoretical week.

Stupid millennials always worrying about their lifestyle. Back in my day, I lived at the hospital. Slept in the call room, took a bath in the scrub sink, cooked my food using a Bovie in the OR, and ate with a scalpel and Adson's off the Mayo stand.

 

[IlDestriero]

A neurosurgery resident I knew transformed the call room into his bedroom complete with a real bed and entertainment system, loveseat, fridge, microwave, etc. for their Q2 hell year.


--
Il Destriero

 

[AnatomyGrey12]

Same applies for residencies. If the program opens up their seat for a couple more residents, the hours can potentially dwindle down from a 100 hour weekly schedule to at LEAST 60 hours a week. Can some argue that this intensive training is to strengthen one's stamina?
But what's the point if, upon completion, they won't work 100 hours/week. Also, I feel that by cutting hours, residents can better absorb their training, and be less prone to burn out before starting out their careers.

Thanks your time!

People already have doubts with whether or not some residencies adequately train their residents even with the hours they currently work. Cutting into that even more just puts patients at risk and creates a bunch of docs with shaky skills. You either have to have residents work a lot of hours or train for more years. Adding years to training would cost a lot of money.

 

[AcademicNeurosurgery]

People already have doubts with whether or not some residencies adequately train their residents even with the hours they currently work. Cutting into that even more just puts patients at risk and creates a bunch of docs with shaky skills. You either have to have residents work a lot of hours or train for more years. Adding years to training would cost a lot of money.

While adding more years would cost money, I do think current residency salaries are daylight robbery, especially during the last year where most are functioning near attending level. Admittedly, I haven't done research into the costs of residency but it would be nice to have a more significant pay increase as you progress through residency. Not sure how feasible that would be.

 

[CherryRedDracul]

How is Europe faring in terms of resident education and their doctor situation with their 48-hour work week?

 

[muhali3]

It's not standard everywhere. I'd say doctors in America work on average 10+ hours more than those in a lot of European countries.

 

[W19]

While adding more years would cost money, I do think current residency salaries are daylight robbery, especially during the last year where most are functioning near attending level. Admittedly, I haven't done research into the costs of residency but it would be nice to have a more significant pay increase as you progress through residency. Not sure how feasible that would be.

I think all residents should should start with 70k/year income, and adjusted upward for high COL areas... But what I think is irrelevant in this matter.

 

[VA Hopeful Dr]

While adding more years would cost money, I do think current residency salaries are daylight robbery, especially during the last year where most are functioning near attending level. Admittedly, I haven't done research into the costs of residency but it would be nice to have a more significant pay increase as you progress through residency. Not sure how feasible that would be.

They still can't bill though so it doesn't matter how they function

 

[W19]

They still can't bill though so it doesn't matter how they function

Even with attending co-signature....

 

[VA Hopeful Dr]

But why can't they? (Outside of "Medicare says so")

That is the answer though

 

[VA Hopeful Dr]

Even with attending co-signature....

Depends what it is

 

[neusu]

Doctors, well residents, hours are an arcane vestige from our fore-fathers of the Halsted era. The young doctors were called residents, as they resided in the hospital for a year while in training. As medical knowledge increased, so too did the duration of training.

In any case, Halsted was a cocaine addict, and subsequently morphine addict in his attempts to quit the cocaine, which had a lot to do with the 48-hour call period and working all day every day. We haven't seriously re-revaluted the training models because it is a quasi-mentorship/apprenticeship model in that those who wish to learn must jump through the hoops set by those willing/able/capable of teaching. Simply put, most attendings attitudes are "I went through it, you work for me now, this is how it has been, this is how it will be." Those who have any sense of compassion towards their junior colleagues, or residual shell-shock from their training, are either drowned out by their more vociferous colleagues who wish to maintain the status quo or are simply too inhibited by the incredible inertia it would require overcoming to change the system.

Finally, as others have mentioned, economically, no one wants to end the current residency model except current residents. Hospitals get near slave labor, attendings get to prop up their cushy lifestyle, and patients get treated. Everyone is happy. We have a saying in neurosurgery that "The beatings will continue until moral improves." No one complains, because a complainer just brings to light everyones misery, which no one wants to be reminded of.

Why do attending doctors work more than 40-hours per week? Well, many don't. For those that do, it is often multi-factorial. Say I was a busy resident, dutifully hitting and logging my 80-hours each week. I fall off the conveyor belt at the other end of residency and am used to working 80-hours. Even 60 feels like a vacation. Add to that the needs of a busy operative practice such as making rounds, first start OR at 7:30 AM, clinic, administrative responsibilities, and perhaps even teaching and the time fills rapidly. Sure, the money is nice, but hopefully I picked a career that makes me happy, I am satisfied with what I do, and enjoy life.

To address your questions whether we could double the number of residents and attendings and cut everyone's hours and pay in half: yes, indeed we could. For the most part, however, the ACGME (who accredits doctors training) has figured out the minimum number of this or that which each doctor needs to do in order to be minimally competent. Cutting the number of hours and doubling the number of docs would only prolong the duration of training to be minimally competent. We could also lower our competencies, or even scrap the entire system and go with something else entirely e.g. anyone who takes and passes Step 1 can practice medicine, but for the most part the feeling is that would be unsafe. As a professional organization, medicine self regulates and self polices. Thus far, despite some bumps in the road here and there, society as a whole seems to be somewhat satisfied with our care of their needs.

 

[AcademicNeurosurgery]

Doctors, well residents, hours are an arcane vestige from our fore-fathers of the Halsted era. The young doctors were called residents, as they resided in the hospital for a year while in training. As medical knowledge increased, so too did the duration of training.

In any case, Halsted was a cocaine addict, and subsequently morphine addict in his attempts to quit the cocaine, which had a lot to do with the 48-hour call period and working all day every day. We haven't seriously re-revaluted the training models because it is a quasi-mentorship/apprenticeship model in that those who wish to learn must jump through the hoops set by those willing/able/capable of teaching. Simply put, most attendings attitudes are "I went through it, you work for me now, this is how it has been, this is how it will be." Those who have any sense of compassion towards their junior colleagues, or residual shell-shock from their training, are either drowned out by their more vociferous colleagues who wish to maintain the status quo or are simply too inhibited by the incredible inertia it would require overcoming to change the system.

Finally, as others have mentioned, economically, no one wants to end the current residency model except current residents. Hospitals get near slave labor, attendings get to prop up their cushy lifestyle, and patients get treated. Everyone is happy. We have a saying in neurosurgery that "The beatings will continue until moral improves." No one complains, because a complainer just brings to light everyones misery, which no one wants to be reminded of.

Why do attending doctors work more than 40-hours per week? Well, many don't. For those that do, it is often multi-factorial. Say I was a busy resident, dutifully hitting and logging my 80-hours each week. I fall off the conveyor belt at the other end of residency and am used to working 80-hours. Even 60 feels like a vacation. Add to that the needs of a busy operative practice such as making rounds, first start OR at 7:30 AM, clinic, administrative responsibilities, and perhaps even teaching and the time fills rapidly. Sure, the money is nice, but hopefully I picked a career that makes me happy, I am satisfied with what I do, and enjoy life.

To address your questions whether we could double the number of residents and attendings and cut everyone's hours and pay in half: yes, indeed we could. For the most part, however, the ACGME (who accredits doctors training) has figured out the minimum number of this or that which each doctor needs to do in order to be minimally competent. Cutting the number of hours and doubling the number of docs would only prolong the duration of training to be minimally competent. We could also lower our competencies, or even scrap the entire system and go with something else entirely e.g. anyone who takes and passes Step 1 can practice medicine, but for the most part the feeling is that would be unsafe. As a professional organization, medicine self regulates and self polices. Thus far, despite some bumps in the road here and there, society as a whole seems to be somewhat satisfied with our care of their needs.

Great points. With regards to increasing the number of docs and lowering competencies, I agree with your comment on Step 1. However, the current system is absolutely garbage. Judging preparedness for residency by an exam taken before stepping foot in a hospital for clinicals is incomprehensible. The fact that people have to limit their specialty choices and change their entire career based on a test they took before M3 is extremely problematic. We need to find better, more objective criteria for assessing specialty-specific residency preparedness.

Everyone in medicine knows these issues exist but, as you mention, the docs with power have the mentality of "I went through it, so you will too". Any attempt to break the status quo and we're lazy/entitled/snowflakes/millennials.

 

[KnuxNole]

Not all doctors work "so many hours". Especially if you have a choice. Lifestyle > All.

 

[emergentmd]

A neurosurgery resident I knew transformed the call room into his bedroom complete with a real bed and entertainment system, loveseat, fridge, microwave, etc. for their Q2 hell year.


--
Il Destriero

Ahhhhhh..... You must be an oldie. I also remember the Q2 NSG call schedule that sometimes lasted 5 straight months. I thought Q3 was tough. Those guys were absolute monsters and looked the part 90% of the time.

 

[Light at end of tunnel]

A neurosurgery resident I knew transformed the call room into his bedroom complete with a real bed and entertainment system, loveseat, fridge, microwave, etc. for their Q2 hell year.


--
Il Destriero

Yuck.

 

[Oh_Gee]

A neurosurgery resident I knew transformed the call room into his bedroom complete with a real bed and entertainment system, loveseat, fridge, microwave, etc. for their Q2 hell year.


--
Il Destriero

imagine all the money you save from $0 rent!

 

[Strider_91]

People already have doubts with whether or not some residencies adequately train their residents even with the hours they currently work. Cutting into that even more just puts patients at risk and creates a bunch of docs with shaky skills. You either have to have residents work a lot of hours or train for more years. Adding years to training would cost a lot of money.

This simply cannot be true because we have PAs who go to school for literally two years and almost everyone on this forum thinks they are about to take over primary care and CRNA are going to take over anesthesia. The last time I went to the ER I did not see a physician. The last time a loved one went to the dermatologist they did not see a physician. The last time someone in my family went to an urgent care....you guessed it, they did not see a physician. Doctors not being able to work less hours in residency because they won't have adequate training and PAs effectively functioning as dermatologists and people accepting that are antithetical.

As an SDN community We either have to accept that PAs and NP aren't actually going to take our jobs in the future or we should start realizing maybe physicians in certain specialties don't need to be worked like dogs to be effective clinicians.

/rant

 

[AnatomyGrey12]

and almost everyone on this forum thinks they are about to take over primary care and CRNA are going to take over anesthesia.

Key caveat bolded. They aren't going to take over, lots of reasons why. CRNAs talk a big talk but they run to the Anesthesiologist the moment the crap even looks like it will hit the fan.

The last time I went to the ER I did not see a physician.

So?

The last time a loved one went to the dermatologist they did not see a physician.

So?

The last time someone in my family went to an urgent care....you guessed it, they did not see a physician.

So?

Doctors not being able to work less hours in residency because they won't have adequate training and PAs effectively functioning as dermatologists and people accepting that are antithetical.

They aren't functioning as dermatologists.... they generally see the known low acuity patients because the waits to see the real dermatologist are months long.

We either have to accept that PAs and NP aren't actually going to take our jobs in the future

They aren't.

I'm sorry the idea of working long hours gets you so worked up.

 

[masaraksh]

I'm sorry the idea of working long hours gets you so worked up.

Are you in med school yet?

 

[AnatomyGrey12]

Are you in med school yet?

Give me a month and ask that. Doesn't matter though, as I have worked very long intern level hours in my life. People who are so worked up about residency hours tend to not have worked hours like that before.

That's not really the issue though, just saying "well PAs do this wth less time" isn't really an argument. If you want PA hours then it would probably be best to become a PA.

 

[Strider_91]

Give me a month and ask that. Doesn't matter though, as I have worked very long intern level hours in my life. People who are so worked up about residency hours tend to not have worked hours like that before.

That's not really the issue though, just saying "well PAs do this wth less time" isn't really an argument. If you want PA hours then it would probably be best to become a PA.

I'm not afraid to work long hours. I don't want to be a PA I am simply saying that this attitude that physicians need longer and longer training is interesting to me. Cause there are mid-levels practicing with two years of schooling. I guess the caveat is if they get sued, the physician is on the chopping block anyway.

 

[AnatomyGrey12]

I'm not afraid to work long hours. I don't want to be a PA I am simply saying that this attitude that physicians need longer and longer training is interesting to me. Cause there are mid-levels practicing with two years of schooling. I guess the caveat is if they get sued, the physician is on the chopping block anyway.

True, but you do have to consider that mid-levels generally only see the low acuity patients, can't perform a number of procedures, and then the whole malpractice insurance thing.

 

[Favoritefarm]

Doctors, well residents, hours are an arcane vestige from our fore-fathers of the Halsted era. The young doctors were called residents, as they resided in the hospital for a year while in training. As medical knowledge increased, so too did the duration of training.

In any case, Halsted was a cocaine addict, and subsequently morphine addict in his attempts to quit the cocaine, which had a lot to do with the 48-hour call period and working all day every day. We haven't seriously re-revaluted the training models because it is a quasi-mentorship/apprenticeship model in that those who wish to learn must jump through the hoops set by those willing/able/capable of teaching. Simply put, most attendings attitudes are "I went through it, you work for me now, this is how it has been, this is how it will be." Those who have any sense of compassion towards their junior colleagues, or residual shell-shock from their training, are either drowned out by their more vociferous colleagues who wish to maintain the status quo or are simply too inhibited by the incredible inertia it would require overcoming to change the system.

Finally, as others have mentioned, economically, no one wants to end the current residency model except current residents. Hospitals get near slave labor, attendings get to prop up their cushy lifestyle, and patients get treated. Everyone is happy. We have a saying in neurosurgery that "The beatings will continue until moral improves." No one complains, because a complainer just brings to light everyones misery, which no one wants to be reminded of.

Why do attending doctors work more than 40-hours per week? Well, many don't. For those that do, it is often multi-factorial. Say I was a busy resident, dutifully hitting and logging my 80-hours each week. I fall off the conveyor belt at the other end of residency and am used to working 80-hours. Even 60 feels like a vacation. Add to that the needs of a busy operative practice such as making rounds, first start OR at 7:30 AM, clinic, administrative responsibilities, and perhaps even teaching and the time fills rapidly. Sure, the money is nice, but hopefully I picked a career that makes me happy, I am satisfied with what I do, and enjoy life.

To address your questions whether we could double the number of residents and attendings and cut everyone's hours and pay in half: yes, indeed we could. For the most part, however, the ACGME (who accredits doctors training) has figured out the minimum number of this or that which each doctor needs to do in order to be minimally competent. Cutting the number of hours and doubling the number of docs would only prolong the duration of training to be minimally competent. We could also lower our competencies, or even scrap the entire system and go with something else entirely e.g. anyone who takes and passes Step 1 can practice medicine, but for the most part the feeling is that would be unsafe. As a professional organization, medicine self regulates and self polices. Thus far, despite some bumps in the road here and there, society as a whole seems to be somewhat satisfied with our care of their needs.

Probably the most thoughtful and insightful post i have read on sdn.

Sent from my SM-G900V using SDN mobile

 

[Stagg737]

I'm not afraid to work long hours. I don't want to be a PA I am simply saying that this attitude that physicians need longer and longer training is interesting to me. Cause there are mid-levels practicing with two years of schooling. I guess the caveat is if they get sued, the physician is on the chopping block anyway.

And once you get some medical school and clinical rotations under your belt, you'll see how woefully inadequate the knowledge base of many, perhaps most, midlevels actually is. I recently did a rotation where an NP with 20+ years nursing experience was rotating with the med students for a few weeks because she was going to start seeing patients independently at the local health department. It blew all our minds how often she either got the diagnosis right and wanted to give the wrong tests/treatment (steroids taper for any patient with a cough, X-rays for sinus infections, etc) or just got a diagnosis completely wrong. Even worse was she was still making the same mistakes 3 weeks later after seeing similar cases. Talking with other physicians and med students, mid-levels with this level of clinical acuity is very common. So the argument that because mid-levels are practicing independently with only 2 years of schooling is only sound if you're okay with unacceptable standards of treatment.

 

[BigRedBeta]

This simply cannot be true because we have PAs who go to school for literally two years and almost everyone on this forum thinks they are about to take over primary care and CRNA are going to take over anesthesia. The last time I went to the ER I did not see a physician. The last time a loved one went to the dermatologist they did not see a physician. The last time someone in my family went to an urgent care....you guessed it, they did not see a physician. Doctors not being able to work less hours in residency because they won't have adequate training and PAs effectively functioning as dermatologists and people accepting that are antithetical.

As an SDN community We either have to accept that PAs and NP aren't actually going to take our jobs in the future or we should start realizing maybe physicians in certain specialties don't need to be worked like dogs to be effective clinicians.

/rant

Yes this is true, and every attending in a high acuity specialty has multiple stories of mid-level providers who wrote off a severe constellation of symptoms as something much more mundane and sent the patient home, resulting in severe morbidity or even death of a patient. In my case (as a PICU attending) the two kids that come to mind were both sent home with zofran for vomiting - one was in heart failure due to viral myocarditis resulting in several weeks on ECMO and a heart transplant while the other had a malrotation and ended up losing 140 cm of small bowel and was TPN dependent for several years and only recently has been able to tolerate normal enteral feedings. Reviewing the chart for the first kid, they had documented capillary refill time of > 5 seconds and in the second they documented 5 days worth of vomiting without diarrhea, both of which should have raised red flags but didn't. I've got probably a dozen more stories like this but those two have stuck with me the most.

Yes, care provided independently by mid-levels for highly algorithmic conditions is the equal of physicians, but the whole idea behind standardization of therapy is so that everyone does well. The outliers are where MD/DO length of training is so vitally important

 

[Stagg737]

Yes this is true, and every attending in a high acuity specialty has multiple stories of mid-level providers who wrote off a severe constellation of symptoms as something much more mundane and sent the patient home, resulting in severe morbidity or even death of a patient. In my case (as a PICU attending) the two kids that come to mind were both sent home with zofran for vomiting - one was in heart failure due to viral myocarditis resulting in several weeks on ECMO and a heart transplant while the other had a malrotation and ended up losing 140 cm of small bowel and was TPN dependent for several years and only recently has been able to tolerate normal enteral feedings. Reviewing the chart for the first kid, they had documented capillary refill time of > 5 seconds and in the second they documented 5 days worth of vomiting without diarrhea, both of which should have raised red flags but didn't. I've got probably a dozen more stories like this but those two have stuck with me the most.

Yes, care provided independently by mid-levels for highly algorithmic conditions is the equal of physicians, but the whole idea behind standardization of therapy is so that everyone does well. The outliers are where MD/DO length of training is so vitally important

I'd even question the efficacy of midlevels for the highly algorithmic conditions. Idk how many patients on my FM rotation (was in an outpatient clinic) came in after the treatment they got from an urgent care center failed. It seems like certain midlevels (especially those working at urgent care centers) go straight to steroids or Z-paks for literally everyone that walks in the door regardless of what their symptoms beyond a cough is...

 

[guytakingboards]

For attendings: I think the OP is massively underestimating the costs of bringing in extra-man power (salary, benefits, etc...). It's a really big deal.

For residents: The intensity of residencies is not to build stamina, its to build acumen. Regardless of the speciality it's all about volume and repetition. As a radiologist, I need to see not only common things presenting commonly but also common things presenting uncommonly and total zebras. Same thing for the surgeon, he needs to master the uncomplicated lap chole but also deal with a few complicated ones as well as liver transplants. The internist needs to see diabetes and its common complications but also uncommon complications like diabetic mastopathy.

If you cut my clinical time by 25%, that's equal to an entire year's worth of clinical material I'm being shorted. Do I love the long hours? Heck no. Is the volume and repetition extremely important to my training? Yes.

 

[DBV]

Give me a month and ask that. Doesn't matter though, as I have worked very long intern level hours in my life. People who are so worked up about residency hours tend to not have worked hours like that before.

That's not really the issue though, just saying "well PAs do this wth less time" isn't really an argument. If you want PA hours then it would probably be best to become a PA.

Yeah ask him in a month then he'll be a first year and he'll show you what's what!

 

[AnatomyGrey12]

Yeah ask him in a month then he'll be a first year and he'll show you what's what!

That's my whole point.... that just because someone is just a little further in the process than someone else doesn't mean the second person doesn't know anything...

 

[masaraksh]

The funniest thing is that people on SDN **** on gen surg because of hours, but then get huge erections for ortho. Oh wait, ortho is same if not more hours...

 

[AnatomyGrey12]

The funniest thing is that people on SDN **** on gen surg because of hours, but then get huge erections for ortho. Oh wait, ortho is same if not more hours...

Oh come on man, bone$ are cool... same with $kin

 

[masaraksh]

Oh come on man, bone$ are cool... same with $kin

gen surgeons are far from starving...

 

[ConfusedChemist]

Cause med school is really expensive. And we don't get pensions. That's a big part of it

 

[AnatomyGrey12]

gen surgeons are far from starving...

Oh yeah I know. I was agreeing with you and making fun of how people complain about hours but look the other way the moment the pay increases like with ortho compared to gen surg.

 

[mistafab]

When did you become such a crusty old guy?

Stupid millennials always worrying about their lifestyle. Back in my day, I lived at the hospital. Slept in the call room, took a bath in the scrub sink, cooked my food using a Bovie in the OR, and ate with a scalpel and Adson's off the Mayo stand.

Hehe anyway OP I've seen lots of different docs, not all of them work more than 40h a week. Many don't. Also - you gotta think about the med school process itself. It selects for people who at least partially enjoy their work.

I was speaking with my lawyer uncle in law. He works probably 80 hrs a week, and has probably done that for 40 years. But if you ask him, he doesn't really work because he loves what he does. I came into medicine because my silly job at a hospital was something I really enjoyed, and I am someone who usually looks forward to doing work. I'll probably live at the hospital most my life not because it is taking away something from me, but because to me it is fun. Like a video game with high stakes, where you need to be the best because otherwise it can be game over for someone. Some people complain about everything, and those are the people you always hear. The people enjoying it don't really say anything so you never hear them.

 

[Affiche]

Give me a month and ask that. Doesn't matter though, as I have worked very long intern level hours in my life. People who are so worked up about residency hours tend to not have worked hours like that before.

That's not really the issue though, just saying "well PAs do this wth less time" isn't really an argument. If you want PA hours then it would probably be best to become a PA.

That's my whole point.... that just because someone is just a little further in the process than someone else doesn't mean the second person doesn't know anything...

Not that I really want to get into it with you but the hours in medicine are just...different...than hours at another job. I was also a non-trad who worked 60-80 hours/week before medical school, but it wasn't comparable. The demand on you while you're at work is higher, the pressure is higher, the competitive culture is taxing, and the fact that you're a trainee with no autonomy for years is especially differentiating (for me, anyway). Couple all of that with the erratic hours and required studying of dense material while exhausted, and you've got a perfect recipe for a generation of lifestyle> pay preferences. People just get sick of the rat race that is medical training.

 

[AnatomyGrey12]

Not that I really want to get into it with you but the hours in medicine are just...different...than hours at another job. I was also a non-trad who worked 60-80 hours/week before medical school, but it wasn't comparable. The demand on you while you're at work is higher, the pressure is higher, the competitive culture is taxing, and the fact that you're a trainee with no autonomy for years is especially differentiating (for me, anyway). Couple all of that with the erratic hours and required studying of dense material while exhausted, and you've got a perfect recipe for a generation of lifestyle> pay preferences. People just get sick of the rat race that is medical training.

And I totally understand that that. My whole point honestly has nothing to do with that, it is focused completely on the idea that just because PAs do somethings with less training doesn't mean that it is an argument for less training for physicians. That was the poster's main argument that I was refuting. Just because a PA can see a low acuity issue in the ED doesn't mean you can cut down EM residency for physicians who need to be ready to handle the train wreck that comes through the door.

I get the desire for lifestyle and that is why lifestyle fields are so competitive, but if the PA hours are so appealing then go be a PA, there isn't anything stopping anyone from doing that. But if people want the knowledge and pay of a physician well yeah that takes more work and time than becoming a PA.

 

[Affiche]

And I totally understand that that. My whole point honestly has nothing to do with that, it is focused completely on the idea that just because PAs do somethings with less training doesn't mean that it is an argument for less training for physicians. That was the poster's main argument that I was refuting. Just because a PA can see a low acuity issue in the ED doesn't mean you can cut down EM residency for physicians who need to be ready to handle the train wreck that comes through the door.

I get the desire for lifestyle and that is why lifestyle fields are so competitive, but if the PA hours are so appealing then go be a PA, there isn't anything stopping anyone from doing that. But if people want the knowledge and pay of a physician well yeah that takes more work and time than becoming a PA.

I agree with that, but that's not what I was trying to respond to haha. My point was that it's totally fair for people to criticize the current model, which is demanding and not flawless, and I found your response of "then go be a PA" to be missing the point of others and wanted to respond to it.

"Less training" means different things to different people, too. Our cardiology fellows don't mind their hours, but they love to bitch about how streamlined the neurology residency is and why can't they shave 2 years of IM off their training, too? To them, "less training" doesn't equate them to a midlevel provider, it just streamlines things. I don't have any answers for the issue of hours/years of training, but I do think the people who are worked up about the residency demands have some merit. From what I've seen, the people concerned about residency aren't concerned simply because they haven't had rough hours before, but because they're currently in the model they're criticizing and feel overworked as it is, so the idea of reducing hours/years or streamlining training in some way is appealing.

 

[AnatomyGrey12]

I agree with that, but that's not what I was trying to respond to haha. My point was that it's totally fair for people to criticize the current model, which is demanding and not flawless, and I found your response of "then go be a PA" to be missing the point of others and wanted to respond to it.

"Less training" means different things to different people, too. Our cardiology fellows don't mind their hours, but they love to bitch about how streamlined the neurology residency is and why can't they shave 2 years of IM off their training, too? To them, "less training" doesn't equate them to a midlevel provider, it just streamlines things. I don't have any answers for the issue of hours/years of training, but I do think the people who are worked up about the residency demands have some merit. From what I've seen, the people concerned about residency aren't concerned simply because they haven't had rough hours before, but because they're currently in the model they're criticizing and feel overworked as it is, so the idea of reducing hours/years or streamlining training in some way is appealing.

Can definitely see this, however the post I originally responded to was all about what's PAs can just on two years of training and "if a PA can do it then we should too" mentality. I do agree wth everything you have just said, there are some definite ways that certain training pathways could be streamlined.

 

[Perrotfish]

Not that I really want to get into it with you but the hours in medicine are just...different...than hours at another job. I was also a non-trad who worked 60-80 hours/week before medical school, but it wasn't comparable. The demand on you while you're at work is higher, the pressure is higher, the competitive culture is taxing, and the fact that you're a trainee with no autonomy for years is especially differentiating (for me, anyway). Couple all of that with the erratic hours and required studying of dense material while exhausted, and you've got a perfect recipe for a generation of lifestyle> pay preferences. People just get sick of the rat race that is medical training.

+1. I would also add that when residents say they are working 60-80 hours they are counting their 'work hours' in a way that no other white collar employee does. My 80 hour week in residency was, exclusively, the time I spent seeing patients. The time that I was reading about my patients didn't count. The time that I spent responding to emails after work didn't count. The time I spent doing trainings or renewing certifications didn't count. The time I spent preparing for our never ending series of hospital presentations didn't count. The time I spent sitting on residency committees didn't count. Even the time I spend changing into scrubs didn't even count! If you could work those things into the work day that was great, of course, but most people were lucky to get out the door at the end of their 13 hour shift without having to stay an hour or three late to chart.

When an average lawyer/engineer/attending complains about an 80 hour work week that means they devoted a total of 80 hours to his job. Calculated that way the average 80 hour Resident work week really is closer to 100-110 hours/week.

 

[Affiche]

+1. I would also add that when residents say they are working 60-80 hours they are counting their 'work hours' in a way that no other white collar employee does. My 80 hour week in residency was, exclusively, the time I spent seeing patients. The time that I was reading about my patients didn't count. The time that I spent responding to emails after work didn't count. The time I spent doing trainings or renewing certifications didn't count. The time I spent preparing for our never ending series of hospital presentations didn't count. The time I spent sitting on residency committees didn't count. Even the time I spend changing into scrubs didn't even count! If you could work those things into the work day that was great, of course, but most people were lucky to get out the door at the end of their 13 hour shift without having to stay an hour or three late to chart.

When an average lawyer/engineer/attending complains about an 80 hour work week that means they devoted a total of 80 hours to his job. Calculated that way the average 80 hour Resident work week really is closer to 100-110 hours/week.

I always love when you comment because you're one of the few docs on here whose posts are always hella in touch with reality.

 

[masaraksh]

+1. I would also add that when residents say they are working 60-80 hours they are counting their 'work hours' in a way that no other white collar employee does. My 80 hour week in residency was, exclusively, the time I spent seeing patients. The time that I was reading about my patients didn't count. The time that I spent responding to emails after work didn't count. The time I spent doing trainings or renewing certifications didn't count. The time I spent preparing for our never ending series of hospital presentations didn't count. The time I spent sitting on residency committees didn't count. Even the time I spend changing into scrubs didn't even count! If you could work those things into the work day that was great, of course, but most people were lucky to get out the door at the end of their 13 hour shift without having to stay an hour or three late to chart.

When an average lawyer/engineer/attending complains about an 80 hour work week that means they devoted a total of 80 hours to his job. Calculated that way the average 80 hour Resident work week really is closer to 100-110 hours/week.

What specialty are you in?