No More 16 Hour Cap for Interns

[sinombre]

Good news for those of us starting residency this July.

Source: http://www.medscape.com/viewarticle/877057

"Residency programs can increase shift hours for first-year trainees beginning this July from 16 to 24, with an extra 4 hours to manage patient hand-offs, the Accreditation Council for Graduate Medical Education (ACGME) announced today.

As a result, first-year residents can have shifts as long as more senior residents. However, the maximum number of hours that any resident can log per week remains at 80.

The ACGME states that the new standard, in the making since 2015, will improve continuity of care for patients, clinical teamwork, and the learning experience for residents. However, critics of the policy, which include the American Medical Student Association and the consumer watchdog group Public Citizen, contend that longer shifts for rookie residents increase the odds of sleep deprivation and accidents, putting patients as well as physicians in harm's way.

The decision by the ACGME to relax limits on shifts for first-year residents comes at a time when the problem of physician burnout and suicide is gripping the profession. However, stress doesn't correlate necessarily to hours on the job, said Rowen Zetterman, MD, who co-chaired the ACGME task force that developed the new standard. Residents in emergency medicine are confined to 12-hour shifts but nevertheless experience high levels of burnout, Dr Zetterman told Medscape Medical News.

Dr Zetterman, associate vice chancellor for planning at the University of Nebraska in Omaha, said that the new shift limits for first-year residents are just one part of new ACGME requirements that place a greater emphasis on trainee well-being and safety. For one thing, residency program directors and other members of the clinical team need to monitor residents for signs of depression and burnout.

The ACGME says that its decision to let first-year residents work longer hours is evidenced-based. It points to a study published in the New England Journal of Medicine in February 2016 that found that longer shifts and less rest in between for first-year surgical residents did not affect the rate of serious complications or surgical fatalities. And they were no more dissatisfied with their overall well-being than peers whose shifts were shorter.

Other recent research, however, continues to raise yellow flags about residency work hours. A study appearing last December in the Journal of the American Medical Association reported that almost 20% of general surgery residents don't complete their programs, with one of the top two reasons being an "uncontrollable lifestyle." And according to a study published last June in the Journal of the American College of Surgeons, more than two thirds of general surgery residents in a national survey met the criteria for burnout. Longer hours helped explain why some residents were likely to qualify as burned out. However, the study found high burnout rates "despite the majority of respondents adhering to work hour limitations."

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[tartesos]

It was a stupid rule anyway, what took them so long?



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[caffeinemia]

It was a stupid rule anyway, what took them so long?



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Ehh. There's so little supervision at my program at night that half-dead interns would scare me way more than lack of "continuity of care."

 

[tartesos]

Ehh. There's so little supervision at my program at night that half-dead interns would scare me way more than lack of "continuity of care."

Sooooo, as soon as July 1st comes they are immediately able to overcome sleep and function?
It's a date thing or is it trained?

They need to man the f up and learn to do what some of them will be doing for life.
I need coffee.


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[tartesos]

Ehh. There's so little supervision at my program at night that half-dead interns would scare me way more than lack of "continuity of care."

And the lack of supervision is a program specific issue to your shop, should not be so and has nothing to do with the cap rule. But It can make for more confident residents( in some cases)


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[caffeinemia]

Sooooo, as soon as July 1st comes they are immediately able to overcome sleep and function?
It's a date thing or is it trained?

They need to man the f up and learn to do what some of them will be doing for life.
I need coffee.


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such hard talk. i'm so scurred. I'm sure "they can all man the f up" -- my argument has nothing to do with their emotional wellbeing. it's fear that they start making mistakes inputing orders or giving information that it starts getting scary. So GTFO.

 

[tartesos]

such hard talk. i'm so scurred. I'm sure "they can all man the f up" -- my argument has nothing to do with their emotional wellbeing. it's fear that they start making mistakes inputing orders or giving information that it starts getting scary. So GTFO.

That point was taken. Did not mean to offend you and I fail to notice how I did so I will not apologize and I think you are a big douche.


Making decisions at night with lack of sleep is something that you train for and get better at with time. Interns can't but as soon as July 1st comes and they turn I to residents they are expected to be able to, and this is just a delay in that preparation that should have occurred 1 year before.
The earlier interns start doing it the better they will get at it. This has led to insecure pgy2's all throughout at least the first few months of night float.



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[caffeinemia]

You're entitled to your opinion - you're hard e-peen is a full of douche as well. So right back at ya mr. badass.

Interns also need to man the eff up and start doing whipples as well. Not starting out doing whipples has made it so there are a bunch of insecure pgy2s who can't do whipples for the first 3 months. As if putting the scut monkeys on for 28 versus 16 hours makes a goddamn difference except to their quality of life. The only reprieve from this is that supposedly the studies show no worse patient outcomes, but the meaning of that finding and the weaknesses of that particular study are highly debatable. There's still no data on whether 16 versus 28 hours on makes a goddamn difference to anything except old attendings who can't change with the times. Then again, whole classes of interns at my program graduated from shifts limited to 16 hours to full 27s without a problem, so cry me a river.

 

[ThoracicGuy]

And the lack of supervision is a program specific issue to your shop, should not be so and has nothing to do with the cap rule. But It can make for more confident residents( in some cases)


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Surgery has no caps.

 

[tartesos]

Surgery has no caps.

Shooot what am I doing in the surgical forum?!?!?
Damn you notifications!. This and pre allo are places I only roam into when drunk, and I'm not so...
Peace


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[tartesos]

You're entitled to your opinion - you're hard e-peen is a full of douche as well. So right back at ya mr. badass.

Interns also need to man the eff up and start doing whipples as well. Not starting out doing whipples has made it so there are a bunch of insecure pgy2s who can't do whipples for the first 3 months. As if putting the scut monkeys on for 28 versus 16 hours makes a goddamn difference except to their quality of life. The only reprieve from this is that supposedly the studies show no worse patient outcomes, but the meaning of that finding and the weaknesses of that particular study are highly debatable. There's still no data on whether 16 versus 28 hours on makes a goddamn difference to anything except old attendings who can't change with the times. Then again, whole classes of interns at my program graduated from shifts limited to 16 hours to full 27s without a problem, so cry me a river.

We started on a bad foot, as I was talking for IM interns( didn't realize where I was, damn app is not working well for me and I'm new to tapa sucks).

My apologies kind sir( or madam).

Ttfn


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[tartesos]

You're entitled to your opinion - you're hard e-peen is a full of douche as well. So right back at ya mr. badass.

Interns also need to man the eff up and start doing whipples as well. Not starting out doing whipples has made it so there are a bunch of insecure pgy2s who can't do whipples for the first 3 months. As if putting the scut monkeys on for 28 versus 16 hours makes a goddamn difference except to their quality of life. The only reprieve from this is that supposedly the studies show no worse patient outcomes, but the meaning of that finding and the weaknesses of that particular study are highly debatable. There's still no data on whether 16 versus 28 hours on makes a goddamn difference to anything except old attendings who can't change with the times. Then again, whole classes of interns at my program graduated from shifts limited to 16 hours to full 27s without a problem, so cry me a river.

In some IM programs what has been done is use Pgy3 more in the first few months or have the chief resident "shadow"the new residents for the first 3-4 moths until the new Pgy2's get used to it... so yeah, it has saved 3-4 months of catching up for some programs.

I'll start crying now.


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[deleted50541]

The intern hours rule came into effect the year after my internship. The two biggest changes I saw occur during my residency were an increasing lack of intern ownership for patient care responsibilities and less team camaraderie. This was most evident at our two busiest hospitals, covering trauma and acute general surgery.

It was hell to be on for those 24+ hour calls when I started. But I felt like we were all in it together, helping each other make it through another call. As I moved up in years, I didn't feel that same cohesiveness amongst the group anymore. Especially with the interns, when a new group would come on at 6PM to take the night shift, and then sign out again at 6AM. They came and went so often, I felt like I barely spent anytime with them. I'm glad that rule is going away.

 

[dpmd]

You're entitled to your opinion - you're hard e-peen is a full of douche as well. So right back at ya mr. badass.

Interns also need to man the eff up and start doing whipples as well. Not starting out doing whipples has made it so there are a bunch of insecure pgy2s who can't do whipples for the first 3 months. As if putting the scut monkeys on for 28 versus 16 hours makes a goddamn difference except to their quality of life. The only reprieve from this is that supposedly the studies show no worse patient outcomes, but the meaning of that finding and the weaknesses of that particular study are highly debatable. There's still no data on whether 16 versus 28 hours on makes a goddamn difference to anything except old attendings who can't change with the times. Then again, whole classes of interns at my program graduated from shifts limited to 16 hours to full 27s without a problem, so cry me a river.

Interns are just scut monkeys with no supervision. Sounds like you are at a great program.

And if you want to talk about quality of life, the schedules at my program once the 16hr rule went into effect were much worse for quality of life. At least with post call days you can do stuff like schedule medical/dental/vision care, do any in person banking needed, or do any other activity that needs to be done during normal business hours. Or you can take a nap then get back on schedule by sleeping that night, rather than having to switch back and forth between day shifts and night shifts sometimes more than once in a week just to make sure everything is covered.

 

[Psai]

Interns are just scut monkeys with no supervision. Sounds like you are at a great program.

And if you want to talk about quality of life, the schedules at my program once the 16hr rule went into effect were much worse for quality of life. At least with post call days you can do stuff like schedule medical/dental/vision care, do any in person banking needed, or do any other activity that needs to be done during normal business hours. Or you can take a nap then get back on schedule by sleeping that night, rather than having to switch back and forth between day shifts and night shifts sometimes more than once in a week just to make sure everything is covered.

I like having sunday off because then I can get nothing done on the one day I have off a week. It's really awesome.

 

[ram006]

Ehh. There's so little supervision at my program at night that half-dead interns would scare me way more than lack of "continuity of care."

I guess the chief residents don't answer their phones?

 

[dpmd]

I like having sunday off because then I can get nothing done on the one day I have off a week. It's really awesome.

You could go to church you heathen!

 

[bannie22]

Awful idea. No normal human being would tell you that working 24 hours nonstop is healthy nor safe.
We have taken a huge step back. Rather than improve signouts and creating institutional safety models to improve this "errors in handover" we return to this archaic manner of just working more hours to reduce the number of signouts.

Well. my terns better take tons of 24. less call for me.

 

[ram006]

Awful idea. No normal human being would tell you that working 24 hours nonstop is healthy nor safe.
We have taken a huge step back. Rather than improve signouts and creating institutional safety models to improve this "errors in handover" we return to this archaic manner of just working more hours to reduce the number of signouts.

Well. my terns better take tons of 24. less call for me.

Have you done both? My quality of life was so much worse with the restrictions. That being said, I was pretty burned out at the end of my PGY4 year. We do an inordinate amount of in house trauma call.

 

[dpmd]

I find it really hard to get these things done chief year. It's pretty rare for me to have an early day to try and sneak to the dentist/eye doctor in the afternoon...and even if I do they don't exactly have appointments available at the last moment.

Thank goodness for Saturday office hours at the dentists, and for a hair place that stays open until 10pm (I go to a "trendy" hair place and get a very not trendy haircut solely because they stay open so late).

Yeah, chief year we were on every other day (and traded every other weekend) home call with no such thing as a post call day even if you were operating most of the night. Second half of the year, the fourth years would take some chief nights for us which was helpful.

 

[bannie22]

Have you done both? My quality of life was so much worse with the restrictions. That being said, I was pretty burned out at the end of my PGY4 year. We do an inordinate amount of in house trauma call.

yeah. 24 is awful.

 

[ThoracicGuy]

yeah. 24 is awful.

 

[Winged Scapula]

(I go to a "trendy" hair place and get a very not trendy haircut solely because they stay open so late).

I LOLd thinking about you getting your haircut by someone with multicolored locks and piercings with thumping bass in the background

 

[caffeinemia]

I guess the chief residents don't answer their phones?

1 chief resident, operating. 200+ patient service. Good luck.

 

[caffeinemia]

Interns are just scut monkeys with no supervision. Sounds like you are at a great program.

And if you want to talk about quality of life, the schedules at my program once the 16hr rule went into effect were much worse for quality of life. At least with post call days you can do stuff like schedule medical/dental/vision care, do any in person banking needed, or do any other activity that needs to be done during normal business hours. Or you can take a nap then get back on schedule by sleeping that night, rather than having to switch back and forth between day shifts and night shifts sometimes more than once in a week just to make sure everything is covered.

Good try. 2 weeks of night float each month essentially leaves you with the entire day to get things done. Half days versus 28 hours makes no difference to scheduling. Been there, done that. not a problem. And yes, interns are scut monkeys, if you expect your interns to make critical decisions then you're doing it wrong. Day 1 to 364, I'm not even going to trust the intern to be a competent scut monkey, much less an exhausted scut monkey at the end of 28 hour shifts.

 

[VA Hopeful Dr]

Good try. 2 weeks of night float each month essentially leaves you with the entire day to get things done. Half days versus 28 hours makes no difference to scheduling. Been there, done that. not a problem. And yes, interns are scut monkeys, if you expect your interns to make critical decisions then you're doing it wrong. Day 1 to 364, I'm not even going to trust the intern to be a competent scut monkey, much less an exhausted scut monkey at the end of 28 hour shifts.

I have not found that to be true

 

[caffeinemia]

I have not found that to be true

And I have. Leave it up to each man to assess their situation then. Ultimately, the rule is hear to stay until further changes, so c'est la vie. Still think it's a ****ty rule contrary to what many people here seem to think, but whatever.

 

[ProfMD]

Good try. 2 weeks of night float each month essentially leaves you with the entire day to get things done. Half days versus 28 hours makes no difference to scheduling. Been there, done that. not a problem. And yes, interns are scut monkeys, if you expect your interns to make critical decisions then you're doing it wrong. Day 1 to 364, I'm not even going to trust the intern to be a competent scut monkey, much less an exhausted scut monkey at the end of 28 hour shifts.

I have not found that to be true

And I have. Leave it up to each man to assess their situation then. Ultimately, the rule is hear to stay until further changes, so c'est la vie. Still think it's a ****ty rule contrary to what many people here seem to think, but whatever.

And this is part of the point. For some places, 24-hour call will work better, for others night float will work better. The variables are too numerous to count - speciality, subspecialty service, number of residents, number of patients, acuity of patient care, etc.

This is why the programs should be allowed to decide. That is all the rule change says. There are no rules that interns must work 24 hour shifts. Some places did night float before the 2011 rule change, others won't revert back now that the change is reversed.

If it is that important to an individual residency applicant, s/he can take it into consideration when making the match rank list.

 

[dpmd]

Good try. 2 weeks of night float each month essentially leaves you with the entire day to get things done. Half days versus 28 hours makes no difference to scheduling. Been there, done that. not a problem. And yes, interns are scut monkeys, if you expect your interns to make critical decisions then you're doing it wrong. Day 1 to 364, I'm not even going to trust the intern to be a competent scut monkey, much less an exhausted scut monkey at the end of 28 hour shifts.

Our interns didn't get scheduled for 2 weeks of night float a month. Like I said they flipped back and forth as needed to cover the schedule since we are a small program.

If they are scut monkeys not making any decisions what is your fear about them being sleepy? Now our interns were considered part of the team and began operating day one with a chief or attending, they were also given graded responsibility with the knowledge that in just 18 months from starting they would sometimes be the in house surgeon in charge at night and the leader of the trauma team during the day. So yeah, day one intern may not be deciding how to manage every aspect of a complicated patient, but they are doing more than just putting in orders they are told to put in.

 

[caffeinemia]

Our interns didn't get scheduled for 2 weeks of night float a month. Like I said they flipped back and forth as needed to cover the schedule since we are a small program.

If they are scut monkeys not making any decisions what is your fear about them being sleepy? Now our interns were considered part of the team and began operating day one with a chief or attending, they were also given graded responsibility with the knowledge that in just 18 months from starting they would sometimes be the in house surgeon in charge at night and the leader of the trauma team during the day. So yeah, day one intern may not be deciding how to manage every aspect of a complicated patient, but they are doing more than just putting in orders they are told to put in.

The concern is that even while doing hapless scut, a sleepless physician is not safe. As I've seemed to have reiterated this multiple times here, but seems like people can't seem to understand that -- perhaps you should refrain from 24 hour shifts yourselves. Also the fact that your program cannot schedule around the former rules does not make it invalid at institutions that can.

 

[caffeinemia]

And this is part of the point. For some places, 24-hour call will work better, for others night float will work better. The variables are too numerous to count - speciality, subspecialty service, number of residents, number of patients, acuity of patient care, etc.

This is why the programs should be allowed to decide. That is all the rule change says. There are no rules that interns must work 24 hour shifts. Some places did night float before the 2011 rule change, others won't revert back now that the change is reversed.

If it is that important to an individual residency applicant, s/he can take it into consideration when making the match rank list.

Obviously - but people are up in arms about how the old system sucked. It actually didn't. And it I raised the very legitimate concern that not all human beings function safely or well after 14 or 16 hours or whatever.

 

[dpmd]

The concern is that even while doing hapless scut, a sleepless physician is not safe. As I've seemed to have reiterated this multiple times here, but seems like people can't seem to understand that -- perhaps you should refrain from 24 hour shifts yourselves. Also the fact that your program cannot schedule around the former rules does not make it invalid at institutions that can.

Not agreeing with you is different than not understanding. I am not worried that sleep deprivation is going to be the reason an intern puts in a ridiculous order so much as their lack of knowledge being the cause. If your program can train them better using shorter shifts and the residents want to keep it that way because they agree with you I don't feel the need to stop them (but I will argue that shift work mentality is not a desirable thing in a surgeon). Yet you seem to want to stop my program from returning to something all involved (including the residents) felt was better (and shown to be no less safe despite your concern about sleep deprivation).

 

[dpmd]

Obviously - but people are up in arms about how the old system sucked. It actually didn't FOR ME.

Fixed.

 

[ProfMD]

Obviously - but people are up in arms about how the old system sucked. It actually didn't. And it I raised the very legitimate concern that not all human beings function safely or well after 14 or 16 hours or whatever.

@dpmd beat me to it - it did not such for you / your program.

However, the available literature, most of it for surgical training, raises concerns that resident education suffers and patients are no safer as work hours are more limited for residents.

Human beings that cannot function after 14-16 hours probably should not be surgeons.

 

[dpmd]

@dpmd beat me to it - it did not such for you / your program.

However, the available literature, most of it for surgical training, raises concerns that resident education suffers and patients are no safer as work hours are more limited for residents.

Human beings that cannot function after 14-16 hours probably should not be surgeons.

I know that the perfed viscus patient that comes in during the middle of the night is glad that I have learned to operate well even when I would rather be sleeping. As a surgeon in private practice in a smaller community I don't always get to opt not to do multiple 24 hr calls in a row or in close sequence and there is a limit to what stuff I can put off until I get some sleep (though I do concede that sleep deprivation has real issues so I don't purposefully schedule post call cases and have delayed or gotten someone else to take cases if I am not feeling like I am on my game-but sometimes you can't delay and everyone else is busy so you just rely on your training).

 

[mimelim]

I find it really hard to get these things done chief year. It's pretty rare for me to have an early day to try and sneak to the dentist/eye doctor in the afternoon...and even if I do they don't exactly have appointments available at the last moment.

Thank goodness for Saturday office hours at the dentists, and for a hair place that stays open until 10pm (I go to a "trendy" hair place and get a very not trendy haircut solely because they stay open so late).

And that is why I invested $50 in a nice pair of...

Granted I've been keeping it super short myself since ~7th grade, but spending $50 since age 18 on my hair? Bargain if you asked me...

 

[ProfMD]

And that is why I invested $50 in a nice pair of...

Granted I've been keeping it super short myself since ~7th grade, but spending $50 since age 18 on my hair? Bargain if you asked me...

I knew a resident who used one of these:

My advice - don't do it. Go to a professional or use @mimelim's method.

 

[bannie22]

Obviously - but people are up in arms about how the old system sucked. It actually didn't. And it I raised the very legitimate concern that not all human beings function safely or well after 14 or 16 hours or whatever.

Totally agree. And there remains people in the world ignorant enough to believe that it is safe to be clinically managing patients 16 hours into a shift. Anyone that has done 24 would agree that towards the end of the shifts, the likelihood of making errors increase dramatically. The provider can be sleepy etc... If the hospital are not willing to find coverage, then they need to start doing so. The overbearing argument being the selfish desire of wanting a post call day.

NF is always safer and definitely much more enjoyable and healthy.

The amount of self harm involved with staying awake for 30 hours every few days will eventually add up.
And its too bad that the interns next year will have to share the cake.

 

[mimelim]

Totally agree. And there remains people in the world ignorant enough to believe that it is safe to be clinically managing patients 16 hours into a shift. Anyone that has done 24 would agree that towards the end of the shifts, the likelihood of making errors increase dramatically. The provider can be sleepy etc... If the hospital are not willing to find coverage, then they need to start doing so. The overbearing argument being the selfish desire of wanting a post call day.

NF is always safer and definitely much more enjoyable and healthy.

The amount of self harm involved with staying awake for 30 hours every few days will eventually add up.
And its too bad that the interns next year will have to share the cake.

My experience over the last 5 years of residency would say otherwise. But more than my anecdotal evidence...

The data does not support your arguments. This was studied. Night Float is not safer. It is not more enjoyable for many people and I'd like to see data on "more healthy" before making that call.

 

[dpmd]

My experience over the last 5 years of residency would say otherwise. But more than my anecdotal evidence...

The data does not support your arguments. This was studied. Night Float is not safer. It is not more enjoyable for many people and I'd like to see data on "more healthy" before making that call.

Yeah. Night shift has plenty of known health consequences in other fields. Pretty sure switching shifts also had health consequences.

 

[VA Hopeful Dr]

Totally agree. And there remains people in the world ignorant enough to believe that it is safe to be clinically managing patients 16 hours into a shift. Anyone that has done 24 would agree that towards the end of the shifts, the likelihood of making errors increase dramatically. The provider can be sleepy etc... If the hospital are not willing to find coverage, then they need to start doing so. The overbearing argument being the selfish desire of wanting a post call day.

NF is always safer and definitely much more enjoyable and healthy.

The amount of self harm involved with staying awake for 30 hours every few days will eventually add up.
And its too bad that the interns next year will have to share the cake.

You say the bolded like it's true. Hint: it's not.

 

[surgonc2017]

Maybe some people can't clinically manage patients after 16 hours - they shouldn't be surgeons. There have been a number of studies on patient outcomes for both floor management and operations performed with no difference.

Additionally, this only applies to the PGY-1 level. Did the 16 hour max advocates think they were suddenly more capable of managing patients for 24 hours as a PGY-2? There's no reason in putting this off a year and losing the experience. But if your program director/faculty agrees that the shifts they routinely work aren't safe, I'm sure they'll be easy to convince to keep a night float system.


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[vhawk]

Awful idea. No normal human being would tell you that working 24 hours nonstop is healthy nor safe.
We have taken a huge step back. Rather than improve signouts and creating institutional safety models to improve this "errors in handover" we return to this archaic manner of just working more hours to reduce the number of signouts.

Well. my terns better take tons of 24. less call for me.

Man why didnt anyone think of trying to improve handoffs?

Oh wait people published like hundreds of papers on the topic and zero progress was made, because the problem isnt that the handoffs themselves arent "good enough."

 

[vhawk]

Totally agree. And there remains people in the world ignorant enough to believe that it is safe to be clinically managing patients 16 hours into a shift. Anyone that has done 24 would agree that towards the end of the shifts, the likelihood of making errors increase dramatically. The provider can be sleepy etc... If the hospital are not willing to find coverage, then they need to start doing so. The overbearing argument being the selfish desire of wanting a post call day.

NF is always safer and definitely much more enjoyable and healthy.

The amount of self harm involved with staying awake for 30 hours every few days will eventually add up.
And its too bad that the interns next year will have to share the cake.

Wait....do you think "safe" is like a dichotomous thing? Residents are either "safe" or "not safe" and they flip a switch at some time variable? Its a continuum. It is NEVER safe. And it is never wholly dangerous. You are probably correct that beyond a certain point it becomes progressively less and less safe but its childish reasoning to pretend that at some point it goes from "safe" to "not safe." Its all about tradeoffs. We are talking about adding hours at the margin.

You cant have a strongly held position like this without giving any care to the costs and downsides of what you support. So...outline them for me. You seem very clear on the benefits, which is more well-rested residents. So what are the costs?

 

[vhawk]

You say the bolded like it's true. Hint: it's not.

Yeah. I mean....this is an internet message board, these conversations arent happening in real time. @bannie22 You are allowed to like stop and read and learn things before you post. There is no time pressure!

 

[educ8r]

+1 for clippers. But it is tough to get the back just right.

 

[ThoracicGuy]

Yeah. I mean....this is an internet message board, these conversations arent happening in real time. @bannie22 You are allowed to like stop and read and learn things before you post. There is no time pressure!

Maybe he's too busy learning about podiatry...

 

[Psai]

Totally agree. And there remains people in the world ignorant enough to believe that it is safe to be clinically managing patients 16 hours into a shift. Anyone that has done 24 would agree that towards the end of the shifts, the likelihood of making errors increase dramatically. The provider can be sleepy etc... If the hospital are not willing to find coverage, then they need to start doing so. The overbearing argument being the selfish desire of wanting a post call day.

NF is always safer and definitely much more enjoyable and healthy.

The amount of self harm involved with staying awake for 30 hours every few days will eventually add up.
And its too bad that the interns next year will have to share the cake.

You talk like someone with no experience.

I can be sleepy 1 hour into my day.

Shifts are for the ed.

NF sucks huge balls. One day off a week in the middle of the week and off schedule with the rest of the world? Always tired because by the time you're kinda used to sleeping during the day, you're back to days? Knowing basically nothing about the dozens of patients you're covering and answering pagers for multiple teams?

I'd rather do a 30 hour.

 

[general admission]

You talk like someone with no experience.

I can be sleepy 1 hour into my day.

Shifts are for the ed.

NF sucks huge balls. One day off a week in the middle of the week and off schedule with the rest of the world? Always tired because by the time you're kinda used to sleeping during the day, you're back to days? Knowing basically nothing about the dozens of patients you're covering and answering pagers for multiple teams?

I'd rather do a 30 hour.

NF has been the worst experience of internship so far. That said, a couple of two week blocks and it's over with.

Pretty much all my coresidents say their 30 hours suck more. Still stuck w/ cross coverage, and approx 0 times have any of the residents on their 30 hour felt okay the following morning. It's extremely rare that things are calm enough for sleep. And as if randomly staying up all night repeatedly throughout the year is any better than a couple of two week stints of being nocturnal. Post-call ****ing sucks too, it's just straight to bed.

30 hours only seems like it would make sense for surgical residencies.

 

[LucidSplash]

NF has been the worst experience of internship so far. That said, a couple of two week blocks and it's over with.

Pretty much all my coresidents say their 30 hours suck more. Still stuck w/ cross coverage, and approx 0 times have any of the residents on their 30 hour felt okay the following morning. It's extremely rare that things are calm enough for sleep. And as if randomly staying up all night repeatedly throughout the year is any better than a couple of two week stints of being nocturnal. Post-call ****ing sucks too, it's just straight to bed.

30 hours only seems like it would make sense for surgical residencies.

Well... you realize this is the surgery forum right?