Hi Folks,
I usually start the day by pre-rounding at 0500h. We generally do work rounds at 0600h-0700h depending on the number of patients on service. After work rounds, we generally get orders in for the day and head off to OR or to the clinics, again depending on the service. Transplant, general surgery and vascular tend to have more patients and thus more morning work.
If you are lucky, you may get to grab a bite to eat around noon but you might have to get something to drink and back into the OR or clinic until about 1500h-1600h. After the OR or clinic is done,(clinic can last until 1700-1800h) or you can do a heavy case such as a retroperitoneal resection or hepatic resection in the OR that lasts into the evening. You generally have will spend a couple of hours doing evening chores such as checking in on your sickest patients. Evening rounds can last until 1900h if you are fortunate. If you are on call, you try to get some dinner and some rest because you are going to be called most of the night for consults and putting out fires on the wards.
Typical consults may be insertion of chest tubes and lines or seeing patients who are going to be admitted from the emergency room. You may also have a surgery or two to get done on patients who come in through the ER. Traumas are covered by the trauma service which has its own hours. If there are more than one trauma, the house coverage may be assisting with traumas too.
On a good call night, you may get three to four hours of sleep. To have a good night, you should get good signout from your colleages who have covered their patients well so you are not doing things like writing sleeping pill orders. I always do a recon walk through the ward a little after nurse shift change to head off any calls for clarification of orders.
You try to get some sleep, shower and go onto the next day. In my program, you don't go home after call but leave after evening rounds on the day that you are post call. You may still have to be in the OR or in the clinic on the day that you are post call. I am surprised at how easy it was for me to get used to this schedule. I spend far more than 120 hours in the hospital counting call.
I won't kid you, you need to be in pretty good physical condition to maintain this schedule. You also need to eat well (avoid the junk) and work out when you can. I have even found plenty of time to read and study especially on call nights. I don't watch TV and I don't spend lots of time hanging out with the gang anymore. That's the essence of being a junior resident on general surgery.
What will the new hours mean in terms of my schedule? Probably not too much. These new regs mean that I am responsible for reporting my hours which will cut into my reading and study time. Personally, I don't think things will change very much. I didn't enter General Surgery to be pampered; I entered this program to be trained. My training has been excellent and I have a program director who has made my life here at the hospital very nice. I am not doing scut, I am doing things that only a physician can do. My paperwork is minimal and my OR time is great!
njbmd
