How bad are surgery hours really?

[Knight_MD]

So basically -hypothetically speaking- a surgical resident getting married early in PG-y1 would be the worst decision ever...(?)

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[Winged Scapula]

So basically -hypothetically speaking- a surgical resident getting married early in PG-y1 would be the worst decision ever...(?)

Could be. You might not be able to take time off for a honeymoon early in your internship.

Many people contemplating this sort of action get married at the end of 4th year medical school, when they have some time to take a honeymoon, time to settle into married life before the start of residency.

But what is most important is that your spouse understands what a commitment you and he/she are making to each other and to the surgical lifestyle. If you are moving to a new area where your spouse might not know anyone, you need to make an extra effort to help them adjust to being home alone a lot

 

[oldman]

i've been working hard, but in a new way. responsibility for keeping people alive and pushing my way through resistence in other depts as i try to accomplish the goals of my team. i'm at a program where hours are strictly adhered to, and the hours are hard. i'm loving it though. i think of doing something else and feel sick, though i could use more sleep.

 

[RichL025]

So, speaking of 80-hour workweeks, has anyone read anything, or heard about the experiences of our European & British bretheren?

I understand they have a vastly different system than ours - "registrars" I think they're called, and there is a half-way point in their residency that many can get stuck at, or weeded out entirely...

but I seem to recall the EU labor restrictions are limiting them to something wildly incomprehensible even to us, the 80-hour children... I'm talking like 45 hours a week or so...

Anyone have any knowledge about this? Are old-timey British surgeons griping about the new whipper-snappers and their 45-hour workweek? Have they worked out any more clever methods for staying under those (relatively draconian) restirctions?

 

[RxnMan]

So, speaking of 80-hour workweeks, has anyone read anything, or heard about the experiences of our European & British bretheren?

I understand they have a vastly different system than ours - "registrars" I think they're called, and there is a half-way point in their residency that many can get stuck at, or weeded out entirely...

but I seem to recall the EU labor restrictions are limiting them to something wildly incomprehensible even to us, the 80-hour children... I'm talking like 45 hours a week or so...

Anyone have any knowledge about this? Are old-timey British surgeons griping about the new whipper-snappers and their 45-hour workweek? Have they worked out any more clever methods for staying under those (relatively draconian) restirctions?

The british-trained docs I know (one a surgeon, the other a nephrologist) both have to deal with 80+ hour weeks.

 

[SLUser11]

The british-trained docs I know (one a surgeon, the other a nephrologist) both have to deal with 80+ hour weeks.

......in England? I mean, otherwise your observation doesn't apply to the poster's question. If they're working 80 hours in the US who cares. Or when you said "have" did you mean "had"?

 

[cchoukal]

this week's NEJM (sorry, no time for link) has a commentary on a strike among the union (yes, union!) of german university physicians over an increase in allowable hours to something like 60/week, if I recall. It's interesting to read...

 

[Winged Scapula]

So, speaking of 80-hour workweeks, has anyone read anything, or heard about the experiences of our European & British bretheren?

I understand they have a vastly different system than ours - "registrars" I think they're called, and there is a half-way point in their residency that many can get stuck at, or weeded out entirely...

but I seem to recall the EU labor restrictions are limiting them to something wildly incomprehensible even to us, the 80-hour children... I'm talking like 45 hours a week or so...

Anyone have any knowledge about this? Are old-timey British surgeons griping about the new whipper-snappers and their 45-hour workweek? Have they worked out any more clever methods for staying under those (relatively draconian) restirctions?

You are correct in that physicians in training in most other countries outside of the US work far fewer hours per week. However, their training is longer and in many cases, as you note, not guaranteed.

The intern year (or two) is followed being a house officer (ie, RMO) for a few years, then registration as a registrar and acceptance into an advanced training program (ie, ortho, general surg, hem/onc, etc.)

Even with the fewer hours (they worked on average 60 per week when I was in Oz), there are newer work hour restrictions and the "old timers" are complaining about it. Not so much because they begrudge the younger guys the fewer hours but because they worry about the quality of the training. And just like in the US, there are work hour violations abroad as well.

At any rate, I'm not sure which system I prefer, although as an older person I think I'd prefer 5 years of surgery training right out of medical school at longer hours than 7 or more with fewer hours.

 

[RichL025]

At any rate, I'm not sure which system I prefer, although as an older person I think I'd prefer 5 years of surgery training right out of medical school at longer hours than 7 or more with fewer hours.

As another "older person" (and just an intern) I agree with you <g>. The uncertainty of progression is another issue - I met a British Med Student applying to surgery once, over here on a trauma rotation (naturally) - she mentioned that some programs seldomly advance the housestaff (RMO?) to the next level, to assure themselves both of a steady cheap labor force, and also to keep their own competition down. While that struck me as overly pessimistic, I'm sure there's a grain of truth in there.

 

[Llenroc]

As another "older person" (and just an intern) I agree with you <g>. The uncertainty of progression is another issue - I met a British Med Student applying to surgery once, over here on a trauma rotation (naturally) - she mentioned that some programs seldomly advance the housestaff (RMO?) to the next level, to assure themselves both of a steady cheap labor force, and also to keep their own competition down. While that struck me as overly pessimistic, I'm sure there's a grain of truth in there.

My uncle is a 61 year old orthopedic surgeon in London, who works as an SHO doing locums. He wasn't very academically motivated in his youth, and didn't take some of the certification exams. Also, in his 40's he had something of a religious conversion and didn't work much for 10 years.

His pay is good for the hours he works though.

 

[Dr. Z]

As another person who has finished training and has been out for a couple of years, I thought I might weigh in on the discussion. I would echo what some of the other thoughtful posters have mentioned. To give you an idea of where I am coming from here is a little background information. I was in training for a total of 8 years. Two years of research as a resident and a one-year fellowship in Surgical Critical Care slowed me down a bit! Nearly all of my training took place prior to the 80-hour workweek. Currently, I am a trauma surgeon at a busy, academic, level I trauma center.

As others have said, in order to go into surgery one must truly feel that there is nothing else in medicine that can make them happy. And still, there will be times when you feel like quitting. It is normal to feel like that. I certainly did. I thought about quitting for more than a fleeting moment. I spent a year thinking constantly about it while I was doing research. As hard as that was for me and for my wife, I concluded that I could only be happy in medicine if I were a surgeon. In no way do I regret that decision. I am doing something that I love.

As some of the other posters indicated, each transition you make along the way (from med student to resident to fellow to attending) requires an adjustment. Expectations are different along each step and what is important to you along the way changes as well. Being aware of this can help and can keep one from getting disillusioned along the way. Most of the time, if one truly knows him/her self, he/she will make the right decision. One just has to be honest regarding how he/she feels. Also, to expect that training will be painless is unrealistic. If you thought (or think)that setting limits on hours would ( or will) make you happy in a surgery residency, then, that is probably a misplaced expectation. I tell people who are considering a surgical career to consider how they would feel if there were no 80-hour workweek. This helps them think about how important being a surgeon is to them without the confounding factor of an arbitrary hour limit.

As far as what life is like when you finish training, I must say that my life is good. I make a decent living, I average about 65 hours a week, and I feel like I have plenty of time to spend with my wife and my friends. Sure, there are times, even as an attending, that I get discouraged. I get tired when I have been up for more than 30 hours. I get hungry when I don't get a chance to eat. I feel awful when I don't think that I have taken the best care of my patient. As Dr. Cox said, as the attending it is your name on the chart and you are ultimately responsible (this fact was the hardest thing for me as a new attending BTW. It took me about 9 months before my anal sphincter started to relax a little. And, I thought that it was as tight as it could get while I was a resident!). As far as my life as an attending relative to my life as a resident, I think the biggest difference is that I have control over my schedule. The control that I have over my life overshadows everything else (including the money).

So, there is hope out there. You can be a happy surgeon!

 

[RxnMan]

......in England? I mean, otherwise your observation doesn't apply to the poster's question. If they're working 80 hours in the US who cares. Or when you said "have" did you mean "had"?

They're in Scotland, actually. Both of them are training there (in Scotland) right now and they have 80+ hour work weeks.

 

[RichL025]

this week's NEJM (sorry, no time for link) has a commentary on a strike among the union (yes, union!) of german university physicians over an increase in allowable hours to something like 60/week, if I recall. It's interesting to read...

Just got my issue in the mail. They're not in training - they're attendings both at University clinics, and then (a few months later) at municipal clinics striking for better pay - I think what they were protesting wasn't the hours they worked per se, but the fact that their reimbursement was predicated on the fiction that they were working 38 hour workweeks, when in reality they were in the 60s...

 

[cchoukal]

Just got my issue in the mail. They're not in training - they're attendings both at University clinics, and then (a few months later) at municipal clinics striking for better pay - I think what they were protesting wasn't the hours they worked per se, but the fact that their reimbursement was predicated on the fiction that they were working 38 hour workweeks, when in reality they were in the 60s...

Sort of like how residents' salaraies are predicated on the fiction that they work 40 hrs/week (so it says on my pay stub). The article also showed a graph of physician wages in various EU countries adjusted for purchasing power with dollars. Apart from, I believe, the Netherlands, they really don't make much money.

 

[supercut]

As far as my life as an attending relative to my life as a resident, I think the biggest difference is that I have control over my schedule. The control that I have over my life overshadows everything else (including the money).

You know, that's one of the biggest issues for me right now. I want control of my life back, and it's hard for me to figure out just how much you can have as an attending. I've been having some discussions with some of our attendings, and I'm not liking what I hear. I don't like the constant phone calls that some of them get from their pts (regardless of whether they are on call or not) Or that some medicine attendings will always consult Surgeon X regardless of whether surgeon X is on call that day. The attendings I'm working with now don't seem to have control over their lives. By that I mean they never can be sure that they won't have a late consult, and they have to round every weekend. Maybe trauma allows better control...and I have been considering trauma. Though the trauma attendings at my med school program worked closer to 100 hours a week!

 

[Sebastian.]

.

 

[Blade28]

The attendings I'm working with now don't seem to have control over their lives. By that I mean they never can be sure that they won't have a late consult, and they have to round every weekend.

But they're in academics, right? Things could potentially be better if you worked for an HMO...alternatively, there's always a group practice.

 

[supercut]

Acutally, currently I'm on a rotation with private practice guys who take residents. They work like dogs!

 

[Pilot Doc]

Acutally, currently I'm on a rotation with private practice guys who take residents. They work like dogs!

But that's because they want to (or they value free time less than something else that job provides for them)

 

[fourthyear]

Quote from Kimberli Cox - "I blame the fact that I would have rather slept a few more minutes than get up early to eat breakfast or to make a lunch to take with me to the hospital, or even to have something in my coat pocket." - I can't tell you how many times I HAVE brought my lunch, but I can't find the time to eat it - even getting to that particular fridge to grab the sandwich and walk around eating it is sometimes an impossible task when you have 15 minutes between cases to talk to patient's family, dictate, write orders, and run to quickly look at a consult in the ED - there's no lunch break in surgery residency. Supercut is right - it is somewhat inhumane what is expected of us to frequently go 14 hour days with no food, water, or bathroom time - prisoners get to attend to their basic needs better than that.

And to that med student -or premed? who said supercut was a whiner - really, you have no business criticizing unless you have felt what it feels like to be on your feet for 30+ hours straight 2-3 times a week for weeks on end and the days in between be equally busy 12-15 hour days - nonstop action is what we wanted when we chose surgery, and non-stop action is what we got. You don't know quite how draining it is until you've really felt it for months in a row - it's kinda rough.

So, what I'm thinking is...if we, as the newer, younger, generation of surgeons are all starting to feel this way...is there hope we can all get together and change the system in the future. I mean, of course we all know there will be emergencies, your patient who needs a return trip to the OR unexpectedly right as you were leaving at 6pm - we will never abandon that type of responsibility as surgeons, I know, and I don't want to. But in the day-to-day expections of hours - if we all really want 50-60 hour a week jobs, and are willing to live on a slightly lower salary than the traditional 90 hour/week surgeons, why can't we have that? Will we have the courage to change our future practices and make them what we want? I'd love to go to an interview and have the practice try to entice me to work with them by advertizing that they somehow encourage a shorter work week, more vacation time, more call setups where you round on all your groups' patients on the weekend you're on call and they round for you when you're not on call, giving you true weekends off ( I do know some groups offer this so that you don't have to round every single weekend all year long!). But I wonder if any of this will be encouraged...or if my future co-workers will continue in this tradition of voluntary self-abuse because they somehow think it's expected of surgeons. That somehow if we're wanting to plan to maybe, say, have only a 1/2 day clinic every Wednesday and plan Wednesday afternoon off maybe to pick your kid's up from school and coach their sports team or something, it would no longer be seen as a sign of weakness or a sign that you are somehow a bad surgeon b/c you're not as hardcore as the senoir partners in the group. I really think that instead of so many people having to jump ship and look for other careers, why can't we just change the culture of our own?

This might seem contradictiory b/c I am sometimes somewhat anti-80-hour workweek, and I don't like when the younger residents seem to feel entitiled to walk out the door regardless of what's going on with patients - b/c I know our job is not shift work and there is a higher level of responsibility for the patients we operate on. But after training, I really would prefer to try to tailor my practice to where I could work more like a 40-60 hour week and I'd be willing to work on the lower end of the pay scale to do that. Will I be able to find a job where my partners have a similar mindset about trying to maintain a better work-life balance? I hope so.

 

[Winged Scapula]

Quote from Kimberli Cox - "I blame the fact that I would have rather slept a few more minutes than get up early to eat breakfast or to make a lunch to take with me to the hospital, or even to have something in my coat pocket." - I can't tell you how many times I HAVE brought my lunch, but I can't find the time to eat it - even getting to that particular fridge to grab the sandwich and walk around eating it is sometimes an impossible task when you have 15 minutes between cases to talk to patient's family, dictate, write orders, and run to quickly look at a consult in the ED - there's no lunch break in surgery residency.

Thank you for the clarification - yes, I may have been too "lazy" to want to get up early and make that lunch, but why bother when experience told me that I was unlikely to be able to eat it, or be near enough to go and get it and then eat it to make the effort worthwhile.

I am also finally getting around to having some long-needed dental work because you can't ask to have an afternoon off for a dental appointment during residency can you?! God forbid we actually take care of ourselves. Having regular haircuts now also makes me look so much better!

 

[toxic-megacolon]

What's a Bullcrab?

 

[supercut]

Quote from Kimberli Cox - "I blame the fact that I would have rather slept a few more minutes than get up early to eat breakfast or to make a lunch to take with me to the hospital, or even to have something in my coat pocket." - I can't tell you how many times I HAVE brought my lunch, but I can't find the time to eat it - even getting to that particular fridge to grab the sandwich and walk around eating it is sometimes an impossible task when you have 15 minutes between cases to talk to patient's family, dictate, write orders, and run to quickly look at a consult in the ED - there's no lunch break in surgery residency. Supercut is right - it is somewhat inhumane what is expected of us to frequently go 14 hour days with no food, water, or bathroom time - prisoners get to attend to their basic needs better than that.

And to that med student -or premed? who said supercut was a whiner - really, you have no business criticizing unless you have felt what it feels like to be on your feet for 30+ hours straight 2-3 times a week for weeks on end and the days in between be equally busy 12-15 hour days - nonstop action is what we wanted when we chose surgery, and non-stop action is what we got. You don't know quite how draining it is until you've really felt it for months in a row - it's kinda rough.

So, what I'm thinking is...if we, as the newer, younger, generation of surgeons are all starting to feel this way...is there hope we can all get together and change the system in the future. I mean, of course we all know there will be emergencies, your patient who needs a return trip to the OR unexpectedly right as you were leaving at 6pm - we will never abandon that type of responsibility as surgeons, I know, and I don't want to. But in the day-to-day expections of hours - if we all really want 50-60 hour a week jobs, and are willing to live on a slightly lower salary than the traditional 90 hour/week surgeons, why can't we have that? Will we have the courage to change our future practices and make them what we want? I'd love to go to an interview and have the practice try to entice me to work with them by advertizing that they somehow encourage a shorter work week, more vacation time, more call setups where you round on all your groups' patients on the weekend you're on call and they round for you when you're not on call, giving you true weekends off ( I do know some groups offer this so that you don't have to round every single weekend all year long!). But I wonder if any of this will be encouraged...or if my future co-workers will continue in this tradition of voluntary self-abuse because they somehow think it's expected of surgeons. That somehow if we're wanting to plan to maybe, say, have only a 1/2 day clinic every Wednesday and plan Wednesday afternoon off maybe to pick your kid's up from school and coach their sports team or something, it would no longer be seen as a sign of weakness or a sign that you are somehow a bad surgeon b/c you're not as hardcore as the senoir partners in the group. I really think that instead of so many people having to jump ship and look for other careers, why can't we just change the culture of our own?

This might seem contradictiory b/c I am sometimes somewhat anti-80-hour workweek, and I don't like when the younger residents seem to feel entitiled to walk out the door regardless of what's going on with patients - b/c I know our job is not shift work and there is a higher level of responsibility for the patients we operate on. But after training, I really would prefer to try to tailor my practice to where I could work more like a 40-60 hour week and I'd be willing to work on the lower end of the pay scale to do that. Will I be able to find a job where my partners have a similar mindset about trying to maintain a better work-life balance? I hope so.

Thank you, fouthyear, for your insight. Today was acutally a "light" day...in at 6am, home at 6pm.

You know, I used to be almost as hard core as they come...which is part of the reason why I've been posting on this fourm. If it can get to me, it can get to anybody. I agree with you that the surgery mentality will have to change from the inside, with change coming from younger folks. I just not sure I have the energy to be part of that group anymore. 2 cases today, both fairly long, both were a major struggle from the exposure standpoint, and I was miserable. I kept thinking why am I doing this to myself. On the other hand, nothing else in medicine is all that appealing, and I can't think of anything to do outside of medicine.

We have a colorectal group in town (unfortunately they don't work with residents much) who do exactly what you propose in terms of rounding...there are about 6 of them, they take turns rounding on the entire groups pts each weekend. They have similar philosophy about stuff like daily labs, transfusions, etc, so it seems to work out well for them. The main thing I notice is you rarely see them in the hosptial nights/weekends. The bad this is that they all operate at 3-4 different hosptials, so they have to run around town to see all their pts.

 

[StevenRF]

It's too bad "do no harm" doesn't apply to the surgeon's own health. Anyone know what the life expectancies are for surgeons compared to other physicians and the general population? Although I'm really interested in surgery, the prospect of throwing away any semblance of happiness and freedom isn't lookin to hot as a first year. Are any of you guys able to pursue outside interests?