quitters

[BlondeDocteur]

I think all of us on the cusp of matching into surgery are both excited and slightly terrified. Attrition is highest in surgery of all fields, and you have to think that very few people start a GS residency ambivalent about their career choice. In short, the quitters and the stick-to-it'ers are basically undifferentiated at this point. How can we know for sure we're not quitters?

I've read all of the pubmed indexed articles on attrition out of surgical residencies. It's quite interesting: the consensus seems to be that you can indeed identify factors that predispose people to switch, before they even step foot in the door.

The national rate of attrition is 2% per year, or between 20-25% total (meaning 1/5 to 1/4 of the people who start a categorical surgery residency won't complete it). Most quit before PGY-3 (more in PGY-2 than in internship).

Disaggregating the stats is even more interesting.

UTSW, for example found (http://www.ncbi.nlm.nih.gov/pubmed/18645106) that they lost 35% of their female residents, but only 22% of their males; that age over 29 was strongly correlated with quitting; and that participation in team sports in college was correlated with success. Most interestingly, academic factors-- such as performance in med school or placement on the final rank list-- was not significantly associated with quitting. And minority residents quit less frequently than whites/Asians.

Yale (http://www.ncbi.nlm.nih.gov/pubmed/19178898) was even bleaker for females: 40% quit, versus 25% for men. Being married, surprisingly, was protective against quitting-- presumably because single residents lack the same support system, and might be more depressed about their inability to date or find a spouse due to time constraints.

Emory had similar, though slightly more encouraging stats: 13% of male residents quit, versus 27% of females. (http://www.ncbi.nlm.nih.gov/pubmed/15708164)

And KU-Wichita found that, if anything, resident attrition has worsened since the implementation of the 80-hr work week. (http://www.ncbi.nlm.nih.gov/pubmed/18005766)

Finally, in the editorial comments sections accompanying many of these articles, authors mentioned that "personality characteristics" were most predictive of success, though no program administered personality testing to its residents to identify specific successful traits.

So my question for all of the residents and attendings here is: I'm sure most of you have had colleagues quit. Do you feel you could pick them out early on? Do you believe that 80% of success is simply showing up? And lastly-- to match into surgery you need to have done a third year clerkship (and liked it), plus multiple months in 4th year on surgical services. The lifestyle constraints shouldn't come as a shock, right? Do you think we 4th year students *can* have an accurate picture of what our lives will be like?

(In the spirit of full disclosure I'm a little freaked out about this data because I'm both female and over 29, so by dint of logic no surgical program should have accepted me over a 25-yo ex-rugby playing dude, right?).

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[SLUser11]

Quoting myself from an old discussion about U Penn. I was arguing with a senior student about the assumption that only weak people fail in surgery:

If you're saying I forgot to blame your parents for you being awesome, I apologize.

And, honestly, I have no idea why you are approaching the match the way you are, and your parents may have nothing to do with it. I also believe that in some sick masochistic way, you'll probably be happy at a nightmare program, and you'll carry that cross with great pride.

I definitely am being hard on you in this thread. I will back off a little, especially since in about a week, you will finalize a decision that will completely change your life.

One last super-wordy comment: Remember that most of the residents in this forum were just like you at match time, similar scores, similar desire to be excellent, similar feelings of invincibility, etc. We've all made different decisions on where to train, and bring different perspectives to the table, all of which are more enlightened than your current perspective. Not because we're smarter or better, but because we've lived it.....not for a month-long sub I or a 2-day tour, but for several years of our lives.

Several people have quit surgery, just on SDN, since I started posting here in 2005. Many others have chronicled their daily struggle to get by. Don't assume that they are just the weak ones, and that your fate will be different. These are intelligent, motivated, hard-working residents who struggled to stay afloat in antagonistic environments with little support. Some were able to swim to shore, and others drowned. When they tell you to wear a life jacket, take their warnings to heart. You can still jump in, but use all the tools you have to make an educated decision that can set you up for a healthy surgical education.

Now, to answer your question, weak residents are definitely prone to quitting or getting fired....by "weak" I mean residents that struggle clinically. Often their academics are fine. We've only fired one resident in the last 5 years, and he got 99th percentile on the ABSITE. He has since finished a residency in pathology and is likely much happier.

The keys to success in surgical residency IMHO:

1. Be able to multi-task well. People who are chronically flustered and overwhelmed tend to burn out.

2. Have a strong work ethic. Seems simple, but people can't guess how busy they'll be from a 3rd year clerkship.

3. Have a voracious intellectual appetite. People who constantly ask themselves questions, are curious about why things are done the way that they are, and is constantly seeking out more information....never accepting things at face value, etc. This translates into daily reading.

4. Have a little Obsessive Compulsive Personality Disorder. This will help with numbers 1-3.

5. Pick the right place. See my post in the decisions thread regarding this.

Those things are difficult to teach. Learning to operate is the easy part.

 

[Svidrillion]

And minority residents quit less frequently than whites/Asians.

Did you come across any pubmed references that chronicle the conversion of Asians out of the minority and into the majority?

 

[maxheadroom]

Quoting myself from an old discussion about U Penn. I was arguing with a senior student about the assumption that only weak people fail in surgery:



Now, to answer your question, weak residents are definitely prone to quitting or getting fired....by "weak" I mean residents that struggle clinically. Often their academics are fine. We've only fired one resident in the last 5 years, and he got 99th percentile on the ABSITE. He has since finished a residency in pathology and is likely much happier.

The keys to success in surgical residency IMHO:

1. Be able to multi-task well. People who are chronically flustered and overwhelmed tend to burn out.

2. Have a strong work ethic. Seems simple, but people can't guess how busy they'll be from a 3rd year clerkship.

3. Have a voracious intellectual appetite. People who constantly ask themselves questions, are curious about why things are done the way that they are, and is constantly seeking out more information....never accepting things at face value, etc. This translates into daily reading.

4. Have a little Obsessive Compulsive Personality Disorder. This will help with numbers 1-3.

5. Pick the right place. See my post in the decisions thread regarding this.

Those things are difficult to teach. Learning to operate is the easy part.

All very true, especially number 1. The residents that I've seen who didn't make it struggled most with the ability to manage multiple issues at once.

 

[pnle119]

4. Have a little Obsessive Compulsive Personality Disorder. This will help with numbers 1-3.

QUOTE]

Sadly, that might just be the one single thing I've got going for me.

 

[BlondeDocteur]

Did you come across any pubmed references that chronicle the conversion of Asians out of the minority and into the majority?

UTSW defined "minority residents" specifically as "black and Hispanic." Everyone else-- whiteys, Middle Easterners, Asians, South Asians, etc-- were "non-minority."

 

[Svidrillion]

UTSW defined "minority residents" specifically as "black and Hispanic." Everyone else-- whiteys, Middle Easterners, Asians, South Asians, etc-- were "non-minority."

I see. Seems to be a bit of a misnomer.

 

[BlondeDocteur]

So do you feel that you could identify early on those residents who quit-- not the ones fired for incompetence?

 

[smq123]

And lastly-- to match into surgery you need to have done a third year clerkship (and liked it), plus multiple months in 4th year on surgical services. The lifestyle constraints shouldn't come as a shock, right? Do you think we 4th year students *can* have an accurate picture of what our lives will be like?

I don't know if 4th year students can have an accurate picture of what their lives will be like as residents. I certainly didn't, even though I worked more hours as a sub-I than I do (on certain rotations) as a resident.

Even though the work HOURS may be the same, the mental work LOAD is different - and that, for me, has affected my "lifestyle" more than the actual number of hours has. My first month as an intern, I took care of more patients at a time than I ever did as a med student. I also carried the service pager, which is its own PITA. The first week, I was too tired to do more than just come home and stare at the ceiling for half an hour before I could get up and function again.

Doing something for a month at a time, even though it seems like a lot, is really only a blurry snapshot of what you will be experiencing as a resident.

Plus, as you go through residency, priorities can change. One of the surgery residents that I worked with as a med student was an excellent resident - more than competent, well-liked, a superstar. But during his 2nd year of residency, his wife got a more demanding job, and they rarely saw each other. One of them had to get a more relaxed job if they were ever going to spend time with each other, so he switched into a different field. It happens.

 

[filter07]

Only two factors are relevant in my opinion.

1. tolerance for bullsh_t
2. options

Most surgeons have a high tolerance for BS. There is an unbelievable amount of BS in surgery residency, particularly in the first two years, and especially during internship. Most stick it out. My guess is that the older you are, the less tolerant you are of BS. Another wild guess is that those who were in the military are probably more tolerant of BS, a lot of which has to do with hierarchy.

The second important factor is having viable alternate options. Even if you can't tolerate the BS, if you can't land a different job because your USMLE or ABSITE scores are horrible, then chances are you're not going to quit. Sure there are those who quit medicine altogether, and I have seen one person do that, but that is rare. Most of the people I've seen quit had better options, whether in Anesthesia, Radiology, or a subspecialty like Urology or ENT. The better your options, the easier it is to quit.

Getting fired is a different story altogether.

 

[Winged Scapula]

I think filter has hit it on the head.

In hindsight, I think it is often possible to identify future attrition. Those who left had the same complaints we all did, but seemed much more bothered by them. Perhaps their tolerance for BS was just lower or the pluses of surgery just didn't outweigh the BS for them.

I certainly can own up to the fact that being older than my colleagues made me more likely to be outspoken (especially during medical school where I had a rep, apparently, of being verbal about perceived wrongs), although in the end, I tolerated the BS (having grown up in a military family ) as a means to an end.

 

[ajlmd]

I agree with the others. Inability to tolerate BS is probably the most common reason for those that are not otherwise struggling.

I also think bad match between a program and resident drives some out.

From my observations as a resident and now as an attending, something has to make it worth it to you in the end. Hostile nurses, litiginous society, scrutiny from hospitals/ staff, personal life sacrifice, decreased compensation, and lesser respect compared to other subspecialties is a big price to pay and is just not worth it to some people, even those who were once very excited about surgery.

However, *most* of us that go into it have an inherent work ethic/mentality and satisfaction over what you really can do which somehow outweighs the negatives at the end of the day.

 

[SocialistMD]

Most quit before PGY-3 (more in PGY-2 than in internship).

UTSW
...female residents...
...age over 29...
...participation in team sports in college was correlated with success...
...academic factors was not significantly associated with quitting...
...minority residents quit less frequently than whites/Asians...

Yale
...females...
...Being married was protective...

Emory
...females...

KU-Wichita
...resident attrition has worsened since the implementation of the 80-hr work week...

While everyone's replies kind of hit at the subject at hand (particularly SLUser's multi-tasking point), I think filter summarized these findings most succinctly. Put simply, there are smarter people going into surgery now than there were even 6 years ago (when I applied) who can go into other fields if they choose. There is also a generational change occurring, both in medical student environment as well as society in general. I've cited the trophy kids article before and I'll bring it up again because I think can help explain what we are seeing; they don't have the tolerance for the surgical hierarchy or the BS that we must endure, both internally as well as in the system in which we practice and know they don't have to put up with it, so they leave. Many general surgery applicants today were surgical subspecialty and ROADs applicants 10 years ago and could have applied to those areas now as well. As medical students, they see the 80-hour workweek as something manageable (after all, they did it on their surgery rotation and still "had fun"), but as smq123 stated, the workload is vastly different as a resident.

The reality is, most medical students are coddled during medical school. What is even more unfortunate is that they don't know it because each specialty is trying to make itself seem fun and like something the applicant would want to do for a career. We are told as residents to make sure the med students get to the OR as much as possible and to minimize our pimping and other activities that could be seen as malignant. We are pulling the wool over these students' eyes and are paying the consequences for it in our attrition. I hate to be the grumpy old man in the room, but medical students didn't live by the 80-hour work week when I was a student and we were in the hospital as much as (if not longer than) our residents. Furthermore, on our surgery rotation, we did a lot of floor scut. The medical students at my current program spend the entire day in the OR with the attendings and don't know what floor work looks like. They also don't take overnight call more than once a week (and this is usually on the weekend), as they need to be present in the OR the next day. We show them the glitz and glamour of surgery and then are surprised when they decide they don't want to be surgeons anymore come the start of their second year because it isn't what they thought it was. A lot of this is our own fault. (By the way, I'm not saying medical students should be in the hospital more than residents, but I do think they gain a lot from helping on the floor from time to time instead of just coming in, rounding with the team and spending the rest of the day in the OR)

In the past, surgical resident attrition was because a resident "couldn't cut it." Now, it is because they don't have to. My program has lost 10 residents since I've been here. Eight residents left surgery of their own volition (+/- a little prodding in a couple cases) and went into radiation oncology (x 2), radiology (x 4), pathology (x 1), and anesthesia (x 1, and I'm sure he's lurking around here somewhere with some great insight...). We have "fired" two who still wanted to be surgeons but who were not up to our standard. For those who left of their own accord, they realized they could do what they wanted to do without putting up with the rigors of surgical residency and are now all happy doing something else. Had they had a more realistic perspective on what residency life was like, they probably would have spared themselves the pain and wasted years as a surgical resident.

The lifestyle constraints shouldn't come as a shock, right? Do you think we 4th year students *can* have an accurate picture of what our lives will be like?

I kind of addressed this above, but I don't know that most programs offer that kind of experience to their students. Shadow the junior residents on your team for a week and you might get an impression of what it is that makes people quit. For some, the romanticism of the OR wears off after intern year and they realize it isn't for them. For others, the ends cease to justify the means (read: they can't tolerate the BS).

To answer your original question, could I have predicted those who would quit? Not really. You could see it coming in some of them (mostly those who were fired), but most were very strong residents who just realized they would be as happy in another field.

 

[BlondeDocteur]

Thanks, Socialist, for a fantastic response (and all others).

Being out for away sub-is and on the trail made me realize that there exists enormous spectrum the intensity of MS3 surgery clerkships. It actually made me very proud to go to Columbia-- everyone out in the world thinks that our surgery residency program is 'malignant,' and the student experience was no different. We had this old dinosaur running our clerkship (whom I love and who wrote one of my letters) until recently, and he was 100% old-school in his mentality. I worked well over 100 hrs/week as a third year student, on the floors, in the ER and in the OR. It was the real deal. And as a sub-i, both at home, at NYU, and at UTSW I topped 130/week at a few points. No pain spared. I did 4 sub-is in a row, so I can only hope I have a good take on things.

California was a different ball of wax. Students were so coddled it was absurd. I worked briefly with MS3s who would scrub on plastics cases; they had 25+ hrs a week of protected "academic time", wore long coats, and instructed me to refer to them as "Doctor" in front of patients. Hell no.

 

[montypython]

Thanks, Socialist, for a fantastic response (and all others).
California was a different ball of wax. Students were so coddled it was absurd. I worked briefly with MS3s who would scrub on plastics cases; they had 25+ hrs a week of protected "academic time", wore long coats, and instructed me to refer to them as "Doctor" in front of patients. Hell no.

As a California surgical resident I completely agree that the coddling most of the students is absurd. They spend more time in class than they do on the floor. And their clinical responsibilities and call requirement are laughable. At my program they are only required to take call twice a month and can only see 2-3 patients max. Most residents do not ask more out of them because the students will quickly complain to the course coordinator and we end up having a sit down meeting discussing how to be less "malignant". I strongly believe that students from this type of environment do not appreciate the workload of a surgical residency and are the ones who are predestined to quit if they enter surgery.

 

[MattD]

California was a different ball of wax. Students were so coddled it was absurd. I worked briefly with MS3s who would scrub on plastics cases; they had 25+ hrs a week of protected "academic time", wore long coats, and instructed me to refer to them as "Doctor" in front of patients. Hell no.

I agree with most of your case, but what exactly is wrong with scrubbing a plastics case? Too much suturing and not enough retracting???

 

[BlondeDocteur]

nothing at all is wrong with scrubbing cases, plastics or otherwise. That phrase was simply exposition in my gripping dramatic narrative, explaining how I happened to meet these MS3s.

 

[FrostNJ]

Thanks, Socialist, for a fantastic response (and all others).

It actually made me very proud to go to Columbia-- everyone out in the world thinks that our surgery residency program is 'malignant,' and the student experience was no different. We had this old dinosaur running our clerkship (whom I love and who wrote one of my letters) until recently, and he was 100% old-school in his mentality.

After reading this quote it made me think about something that I take for granted about the surgical field as an MS3 that will be applying next year:

Malignancy - Surgery has a well established reputation for a high amount of malignancy (some programs more than others), but I really started to wonder whether it was really necessary. I, much like the poster here, feel proud to say I want to do G surg, and this quote exemplifies one of the reasons - I was able to succeed on the clerkship despite this malignancy. But that got me thinking, does this type of managerial style make me perform better? Maybe, but would a style that is based on partnership make me perform even better? And why is this such a large part of the surgical culture? I think there's a belief that its a part of the rite of passage through surgery residency, but I'm not really sure why. I enter the field of surgery knowing that malignancy will be an innate part of it, and believe that it is actually a great motivator for me to improve. But what about those who don't respond to this type of motivation? Are they not fit to be surgeons? And are these the types of minds who tend to quit? I don't know the answer to these questions, but was curious what you all thought.

 

[Winged Scapula]

I enter the field of surgery knowing that malignancy will be an innate part of it, and believe that it is actually a great motivator for me to improve. But what about those who don't respond to this type of motivation? Are they not fit to be surgeons? And are these the types of minds who tend to quit?

I think it quite a leap from someone not responding to "malignancy" as a motivator to saying that they are "not fit" to be surgeons.

I, on several occasions during my residency, made the comment that "screaming at me does not motivate me to work harder/read more/be your bitch, etc." If anything, it made me bitter and less likely to do the afore-mentioned but I don't think it meant that I was less fit than anyone else.

As long as you have internal motivation and can tolerate the BS, IMHO there is no role in using malignancy, threats, etc. as a motivator. Adult learning theory tells us exactly that. The fitness in being a surgeon is not dependent on being motivated by BS.

 

[SLUser11]

I worked well over 100 hrs/week as a third year student, on the floors, in the ER and in the OR. It was the real deal. And as a sub-i, both at home, at NYU, and at UTSW I topped 130/week at a few points.

While I by no means disbelieve your personal story, because I know that it does happen, I think it's funny that most medical students from "malignant" programs easily recall and advertise their 120-130 hour weeks. I think their math is a little off most of the time. I had students from my home program working the same hours as me, but their math added 20-30 hours at the end of the week.

Usually, these numbers are not realistic. And, if they are, you should immediately start running away from that program.

If you were on call q 2 days and started call days at 4am, then stayed until 6pm every post call day, which is uncommon, you would work 136 hours.

If it were a q3 schedule, with the student starting at 4:30am, working all night, then staying until 5pm on the post call day...maybe working until 8pm on non-call days.....Even if they get 3 calls in that week, they only work 123.5 hours/week.


I just very rarely have seen students working that hard. Now, I know that this post will produce some responses vividly recalling these intense clerkship hours, so I'm just going to say that I think in general students exagerrate their hours a little bit.

I enter the field of surgery knowing that malignancy will be an innate part of it, and believe that it is actually a great motivator for me to improve.

It's a common mistake to assume that malignant environments are both ubiquitous and necessary. If anything, these assumptions empower the malignant programs and allow them to continue their caveman approach to surgical education.

 

[BlondeDocteur]

130 was only at UTSW.

I was in the hospital every morning by 3:30. It was my responsibility to round on the entire service, write the notes, make the vitals crib sheet, take down the dressings and get dressing supplies to the bedside by the time rounds began at 5:15-5:30. Since I am still a med student this took me longer than others, so for 20 patients I would allot 2 hours.

We usually operated until 11 PM, including transferring the patient to the recovery room, making sure the orders were OK, doing one final sweep of the floors, etc. Occasionally 1 AM.

Call was q5 for students. We came on weekends as well, like normal days, though rounds were later (like 7).

So 3:30 - 11 is 19.5 hrs/day. One call night in the week was 24 hours for that day.

In a week with one call day, (19.5*4) [non-call weekdays] + (17*2) [non-call weekends] + 24 [call day] = 136.

It was surreal. To make it worse I absolutely couldn't do anything when I got home, let alone read for the next day's cases, so I was getting up at 1:30 AM to read for the OR.

It was awful and I was absolutely shattered by the end of it. There was NO WAY I could keep that up for anything remotely approaching 5 years, and am in complete awe of people who worked those hours routinely Back In The Day.

UTSW-Parkland was a special place. The residents were fully aware of how eager the plastics sub-is were to make a good impression and just had us do everything. They were so stressed and exhausted that they used us mercilessly to lighten their load.

That being said, there is definitely a small amount of pride that I worked those hours and survived with a nice letter of recommendation.

Everywhere else was more normal, 100 hrs/wk.

 

[agranulocytosis]

 

[Winged Scapula]

While thankfully unusual these days, it was not uncommon in the old days, and you can still see some old school places that work their students and residents like this.

 

[vhawk]

"Not uncommon?" To be putting in CONSISTENTLY 20 hour days? Come on. From time to time, sure. 17-18 hour days, maaaaaybe. But I find it basically impossible to believe that anyone, at any time, was consistently working 20 hour days, at any point in the history of surgical training. Its barely conducive to life, much less education. SLUser had it dead on, most med students exaggerate a little, but no one exaggerates more than when talking about "the good old days."

SLUser with some really good posts ITT, makes me wonder if I met him/her when I interviewed at Wichita!

 

[Moonglow]

...............................

 

[SocialistMD]

That being said, there is definitely a small amount of pride that I worked those hours and survived with a nice letter of recommendation.

"Not uncommon?" To be putting in CONSISTENTLY 20 hour days? Come on. From time to time, sure. 17-18 hour days, maaaaaybe. But I find it basically impossible to believe that anyone, at any time, was consistently working 20 hour days, at any point in the history of surgical training. Its barely conducive to life, much less education. SLUser had it dead on, most med students exaggerate a little, but no one exaggerates more than when talking about "the good old days."

SLUser with some really good posts ITT, makes me wonder if I met him/her when I interviewed at Wichita!

I still look back fondly on my transplant sub-i at Pitt as the rotation when I proved to myself I could do anything. In the process of scrubbing 28 liver transplants, 5 multi-visceral transplants and a couple of big surg onc abdominal whacks in my 30 days there, I completed a 72-consecutive hour period of time in the hospital (personal record, even when my wife was in the hospital having our daughter) and routinely spent 20 hours a day in the hospital (5:30 am - 6 pm in the hospital, home for dinner/nap, back to the hospital at around 9 for the night's festivities, back home [some nights] by 4:00 to return at 5:30). Since I was doing an away in a city where I knew no one, I only took 1/2 of a day off when my wife (girlfriend at the time) came up to visit me. Towards the end, I developed terrible burning in my lower legs and realized I had pitting edema. Good times. Was it necessary or would I ever want to do it again? No, but it was nice to prove to myself that, for a least a month, I could. I guess it is like people who run marathons to say they can. My marathon just happened to involve a month in a hospital (which, honestly, is probably the same result I would have if I actually tried to run a marathon...).

 

[vhawk]

I still look back fondly on my transplant sub-i at Pitt as the rotation when I proved to myself I could do anything. In the process of scrubbing 28 liver transplants, 5 multi-visceral transplants and a couple of big surg onc abdominal whacks in my 30 days there, I completed a 72-consecutive hour period of time in the hospital (personal record, even when my wife was in the hospital having our daughter) and routinely spent 20 hours a day in the hospital (5:30 am - 6 pm in the hospital, home for dinner/nap, back to the hospital at around 9 for the night's festivities, back home [some nights] by 4:00 to return at 5:30). Since I was doing an away in a city where I knew no one, I only took 1/2 of a day off when my wife (girlfriend at the time) came up to visit me. Towards the end, I developed terrible burning in my lower legs and realized I had pitting edema. Good times. Was it necessary or would I ever want to do it again? No, but it was nice to prove to myself that, for a least a month, I could. I guess it is like people who run marathons to say they can. My marathon just happened to involve a month in a hospital (which, honestly, is probably the same result I would have if I actually tried to run a marathon...).

I'm sure it was rewarding to know you could do it, and I've had a rotation or two that was similar (but not quite as bad) that I was proud I handled like an adult. But imagine this being the norm for a 5 year training program, month in and month out. Its preposterous. Human beings werent made out of tougher stuff 40 years ago, and the haze of time obscures reality a bit.

 

[Winged Scapula]

I'm sure it was rewarding to know you could do it, and I've had a rotation or two that was similar (but not quite as bad) that I was proud I handled like an adult. But imagine this being the norm for a 5 year training program, month in and month out. Its preposterous. Human beings werent made out of tougher stuff 40 years ago, and the haze of time obscures reality a bit.

It wasn't 40 years ago and I still remember very easily what it was like. I'm afraid you have little business claiming that it wasn't like that.

Yes, we did come in for CT surgery rounds at 0330; yes, we had q2 call on CT and Vascular (even after the work hour regulations) and yes, we did not go home post call. We did not have 1 day in 7 free from clinical duties.

Did I work 120-130 hours a week every week? No but under 100 was rare. And it was not unusual to come in at 0330-0430 and stay until 9-11 pm even post-call. My longest stretch was 42 hours awake. I did not leave the hospital once for 3 days, and this was as a Chief resident on Vascular (well after the 80 hour work week).

Is there some exaggeration? Sure but I believe BD and rather than assume she and the others are lying, we might want to consider that there may be some truth in it. Humans are capable, now AND 40 years ago, of working that many hours. It may make you less interesting, less physically fit and less clear eyed and skinned, but it is not impossible to work these hours.

 

[vhawk]

It wasn't 40 years ago and I still remember very easily what it was like. I'm afraid you have little business claiming that it wasn't like that.

Yes, we did come in for CT surgery rounds at 0330; yes, we had q2 call on CT and Vascular (even after the work hour regulations) and yes, we did not go home post call. We did not have 1 day in 7 free from clinical duties.

Did I work 120-130 hours a week every week? No but under 100 was rare. And it was not unusual to come in at 0330-0430 and stay until 9-11 pm even post-call. My longest stretch was 42 hours awake. I did not leave the hospital once for 3 days, and this was as a Chief resident on Vascular (well after the 80 hour work week).

Is there some exaggeration? Sure but I believe BD and rather than assume she and the others are lying, we might want to consider that there may be some truth in it. Humans are capable, now AND 40 years ago, of working that many hours. It may make you less interesting, less physically fit and less clear eyed and skinned, but it is not impossible to work these hours.

There is a massive difference between 100 and 120-130. The way you know there is a huge difference is by talking to people who work 20-30 hours a week for a living.

You claim that human beings are capable of this. I dont agree. Not for extended periods of time. You rightly claim I dont have experience and wasnt around back then, but thats barely relevant. I have experience being a human being, and rationally evaluating claims. I have experience listening to human beings, and lots of experience with universal human biases.

It is not really in the realm of possibility that it was "not that uncommon" for residents to consistently work 120-130 hours/week, on a regular basis. It IS in the realm of possibility that SOME residents, in some programs, worked 100-110 hours a week, occasionally, for periods of several weeks at a time. Which is very impressive, and nothing at all to scoff at.

If I asked a group of amateur poker players, "How much did you make in poker last year?" they would UNIVERSALLY overestimate what they made, and whats more, they would be able to pass lie detector tests affirming the same. They are not liars. But a rational investigator, even someone who had never played poker before, would be justified in rejecting their claims on the basis of understanding human bias and understanding the economics of poker. This is an analogous situation.

 

[Winged Scapula]

vhawk...

I'm not sure why you persist on insisting you know how it was or how it affects everyone. You weren't there nor do you know how everyone reacts to working such hours. Your lack of experience IS relevant. You cannot talk about how it is not humanly possible to work 120-130 hours per week without having done it yourself or observing others doing it.

And while there is a great deal of difference between 100 hours per week and 130 hours per week, that isn't important. My point was that there were weeks in which we worked less, rotations on which we worked less, but that more was the norm.

While I am not working at the hospital 120-130 hours per week anyone, the fact remains that I sleep about 5 hours per night, or 35 hours per week. This means that I am awake for over 130 hours per week. This isn't possible in your experience yet here I am, doing it day in and day out.

 

[glade]

If I may interject, I think that people are simply misunderstanding one another. I have heard it said that before when people were working 130 hours routinely it was different. There were more residents around to do the work because they were all there post call. And a lot of time was spent looking for hard copies of films or walking down to the lab for results. And there was more down time where they could nap, maybe for thirty minutes. I do not mean to imply that they were all lolly-gagging all day but that's the difference.

Today things are more thinned out and that is why nobody today can believe that people were working that much.

 

[vhawk]

vhawk...

I'm not sure why you persist on insisting you know how it was or how it affects everyone. You weren't there nor do you know how everyone reacts to working such hours. Your lack of experience IS relevant. You cannot talk about how it is not humanly possible to work 120-130 hours per week without having done it yourself or observing others doing it.

And while there is a great deal of difference between 100 hours per week and 130 hours per week, that isn't important. My point was that there were weeks in which we worked less, rotations on which we worked less, but that more was the norm.

While I am not working at the hospital 120-130 hours per week anyone, the fact remains that I sleep about 5 hours per night, or 35 hours per week. This means that I am awake for over 130 hours per week. This isn't possible in your experience yet here I am, doing it day in and day out.

Ok. Obviously I am not going to win an internet argument on SDN against you. I dont really know how to make the argument much clearer than this, but let me give it one last shot. You might be correct. Maybe it really was "not uncommon" for residents to be consistently working 120-130 hours/week. Its impossible for me to know, since I dont have a time machine. But can you at least agree with me that, given the following:

1) I am a human being
2) I have worked 100 hours/week for several weeks in a row, and know what it feels like
3) I have a modest understanding of typical human biases

that it would be absolutely insane for me to accept ANY amount of anecdotal, self-reported recollections, that concluded that it was "not uncommon" for residents to regularly work 120-130 hours? Again, I'm not saying it didnt happen. Maybe it did. Maybe you are right. But as a scientist, you must agree with me. You should be an expert in Bayes, right? It would be impossible to accept it in the face of mere personal anecdote. Jesus himself could come down and tell me that it happened and it would be pretty silly to believe him, right?

The biggest problem with this is its hard for this not to come off as insulting you, and I'm not trying to do that at all. I'm not calling you a liar or anything. I even used the poker player analogy rather than more potentially insulting analogies, like UFO believers or religious followers.

 

[vhawk]

Although I guess if glade is right and the 130 hours that were "not uncommon" to have been worked were less intense hours, with naps etc., and thus it was more similar to 100 hours/week would be now, then it becomes more tenable. I'm not willing to claim its impossible to merely "be awake" for 120-130 hours/week.

 

[vhawk]

Heh, this kind of turned into an interesting argument, in abstraction.

 

[SocialistMD]

1) I am a human being
2) I have worked 100 hours/week for several weeks in a row, and know what it feels like
3) I have a modest understanding of typical human biases

There is nothing "scientific" to your conclusion. It is a simple logic flow, and it has several flaws. You are missing the components "4) All human beings are the same" and "5) My experience is common" Without those components, you can't make the conclusion you make, as you are making it based on your experiences.

It would be impossible to accept it in the face of mere personal anecdote.

Yet, here you are telling her that, based on your personal anecdote, she is wrong. Another reason your logic flow doesn't work.

You are the Spaniards telling Christopher Columbus the world is flat despite the fact that he has already been to the Americas and proven it round. She did work that much. Simply because you can't wrap your brain around the fact that she has worked that much doesn't mean it isn't true. When you get into Q2 and Q3 call, your body becomes automatic and it is actually easier to get up in the morning post-call than it is when you are Q4 or Q5 (at least, that is true for me and for my co-residents with whom I've spoken about this observation).

I can't believe you won't just let it go.

 

[filter07]

One thing about the 120 hours is that it's such an insane amount of work that even those in the medical field have a hard time believing it.

The most I've worked during residency was about 95-100 hours, and that sucked immensely. Every 10 hours on top of 100 must be excruciating. I am not ashamed to say that I would not be in surgery if I had to consistently work 120 hours a week. Nobody should accept work conditions like that for an extended period of time. It is too bad that this kind of abuse went on for decades before an outside body lay the smack down. It goes to show how backwards the field of surgery can be when it comes to basic needs of their trainees.

 

[SocialistMD]

It goes to show how backwards the field of surgery can be when it comes to basic needs of their trainees.

However, it is tough to change when you (the faculty) don't know if you would be as good a surgeon as you are if you hadn't trained that way. That was (and continues to be) a tough answer to tease out and I'm sure I would have felt more guilty for turning an inadequately trained surgeon loose on the community than I would have for putting a resident through the same work conditions I endured when I was in his/her shoes.

 

[Winged Scapula]

T When you get into Q2 and Q3 call, your body becomes automatic and it is actually easier to get up in the morning post-call than it is when you are Q4 or Q5 (at least, that is true for me and for my co-residents with whom I've spoken about this observation).

This is absolutely true.

I had a much harder time adjusting to the less frequent on call as a Chief resident than I did when I was more junior. It was somehow more tiring to be up all night when I did it Q4 or 5 than Q2 or 3. This is a well recognized phenomenon.

I don't know about naps during call but it was certainly filled with busy work like hunting down films, putting lines in (no PICCs, IV teams), "dictation parties" for trauma, etc.

Finally, while you may need more rest, I generally sleep 5 hours per night, so being awake for 130 hours per week is typical for me.

 

[SLUser11]

This is absolutely true.

I had a much harder time adjusting to the less frequent on call as a Chief resident than I did when I was more junior. It was somehow more tiring to be up all night when I did it Q4 or 5 than Q2 or 3. This is a well recognized phenomenon.

I don't know about naps during call but it was certainly filled with busy work like hunting down films, putting lines in (no PICCs, IV teams), "dictation parties" for trauma, etc.

Finally, while you may need more rest, I generally sleep 5 hours per night, so being awake for 130 hours per week is typical for me.

I can't hide the fact that I love it when my posts start an argument......

Anyway, I have no doubt the residents were doing long hours in the past, and that some still are stuck in that environment. I think Glade is also right that the work may have been generally lower-yield back then, and hopefully programs have adapted by optimizing the time residents spend in the hospital.

My opinion, based on my anecdotal experience in 4-5 different environments, is that people tend to round up when it comes to hours.....and med students are guilty of that behavior. Their also guilty of much worse things, like wearing their scrubs and white coat to a restaurant.

This is a generalization and not aimed at BD. Like I said, it does happen, just not as often as it's claimed.




As for Filter's comment, I agree. I doubt that I'd finish a residency with only 5 hours outside the hospital per day. My family is too important for that. Still, even back in the ancient pre-2003 era, there were programs with more reasonable hours.

 

[Buzz Me]

I keep meticulous track of my hours (just for my own records) so always know exactly how much I've worked each week.

My worst stretch was a several-week-long General Surgery rotation where the team usually started pre-rounding around 4:30 am and would be running the list and signing out around 11 pm (sometimes closer to midnight). Call was home call, anywhere from Q1-Q3, so this obviously added quite a few hours to the mix. My record was 130 hours in a week. Let me tell you, that was incredibly painful. But I do agree that once you've been in a pattern of frequent calls for a while, your body adjusts.

 

[vhawk]

There is nothing "scientific" to your conclusion. It is a simple logic flow, and it has several flaws. You are missing the components "4) All human beings are the same" and "5) My experience is common" Without those components, you can't make the conclusion you make, as you are making it based on your experiences.



Yet, here you are telling her that, based on your personal anecdote, she is wrong. Another reason your logic flow doesn't work.

You are the Spaniards telling Christopher Columbus the world is flat despite the fact that he has already been to the Americas and proven it round. She did work that much. Simply because you can't wrap your brain around the fact that she has worked that much doesn't mean it isn't true. When you get into Q2 and Q3 call, your body becomes automatic and it is actually easier to get up in the morning post-call than it is when you are Q4 or Q5 (at least, that is true for me and for my co-residents with whom I've spoken about this observation).

I can't believe you won't just let it go.

Congrats, you are bad at science. How does it feel? Bad, right? Actuallly not even bad at science just bad at logical reasoning. I dont know how to work this into a Christopher Columbus metaphor but give me a day or two and I'll figure a good one out.

 

[Shoushu]

Did I work 120-130 hours a week every week? No but under 100 was rare. And it was not unusual to come in at 0330-0430 and stay until 9-11 pm even post-call. My longest stretch was 42 hours awake. I did not leave the hospital once for 3 days, and this was as a Chief resident on Vascular (well after the 80 hour work week).

.

I'm still a few years away from being resident. My top interests are General Surgery, Anesthesiology, IM. I'm alarmed to hear some residents work 120-hour weeks consistently. Isn't there work hour reform to keep the hours at around 80 hours a week?

Come on, even the Navy SEALs only handle these type of hours once. During Hell Week the SEALs work 120 hours straight, with only a couple hours worth of total nap time, scattered in between. And once they prove that they can handle Navy SEAL hours, they don't train 120-130 hours a week anymore.

Pure physical work is also much easier to handle, and stay awake on, than mental and physical work. I'll give that. I ran 4 marathons (26.2 miles) in my young life, each taking 4-5 hours, but felt like I can handle a 20-hour super-long jog if I wanted. I'm actually eager in completing an Ironman Triathlon. There are blanks when I think about nothing though, like robot.

Winged Scapula mentioned the longest she stayed awake was 42 hours. Is that around max necessary for GS? My longest awake time was exactly 37 to 38 hours maximum (at least 37), undergrad when I had midterms and projects piled on me. I didn't leave the 24/7 study lab except to do 2 exams. MOST MISERABLE TIME IN MY LIFE!~ Almost Dead. not sure if 40 hours AWAKE straight in hospital is better. Not w/ iron will, I chased caffiene pills w/ energy drinks. I don't use illegal stuff.

Btw, do surgeon residents do drugs (come'n fess up) to stay awake? I hear there's high drug use in Anesthesiology. Unrelated, Adderall/Ritalin/ meth/ amphetamine addicts say they stay awake 200-300 hours, partying, video games, STUPID. One said, "18 days awaake straaaiight"

 

[Apollyon]

Come on, even the Navy SEALs only handle these type of hours once. During Hell Week the SEALs work 120 hours straight, with only a couple hours worth of total nap time, scattered in between. And once they prove that they can handle Navy SEAL hours, they don't train 120-130 hours a week anymore.

Point of information: during Hell Week at BUD/S, there is a max of 4 hours of sleep (ie, not guaranteed).

 

[vhawk]

Point of information: during Hell Week at BUD/S, there is a max of 4 hours of sleep (ie, not guaranteed).

Hell Week? Apparently its "not uncommon" in the past to just do this on a regular basis for years at a time. Queers.

 

[SocialistMD]

Congrats, you are bad at science. How does it feel? Bad, right? Actuallly not even bad at science just bad at logical reasoning. I dont know how to work this into a Christopher Columbus metaphor but give me a day or two and I'll figure a good one out.

Oh, snap! You got me good!
It's called emperical data, Bill Nye...

 

[Smurfette]

I'm still a few years away from being resident. My top interests are General Surgery, Anesthesiology, IM. I'm alarmed to hear some residents work 120-hour weeks consistently. Isn't there work hour reform to keep the hours at around 80 hours a week?

Come on, even the Navy SEALs only handle these type of hours once. During Hell Week the SEALs work 120 hours straight, with only a couple hours worth of total nap time, scattered in between. And once they prove that they can handle Navy SEAL hours, they don't train 120-130 hours a week anymore.

Winged Scapula mentioned the longest she stayed awake was 42 hours. Is that around max necessary for GS? My longest awake time was exactly 37 to 38 hours maximum (at least 37), undergrad when I had midterms and projects piled on me. I didn't leave the 24/7 study lab except to do 2 exams. MOST MISERABLE TIME IN MY LIFE!~ Almost Dead. not sure if 40 hours AWAKE straight in hospital is better. Not w/ iron will, I chased caffiene pills w/ energy drinks. I don't use illegal stuff.

Btw, do surgeon residents do drugs (come'n fess up) to stay awake? I hear there's high drug use in Anesthesiology. Unrelated, Adderall/Ritalin/ meth/ amphetamine addicts say they stay awake 200-300 hours, partying, video games, STUPID. One said, "18 days awaake straaaiight"

Yes, work hour rules are 80 hours/week averaged over 4 weeks.
By the rules, the most you should have to be awake would be 30, since you are only allowed to work 30 hours in a row, max.
I have not, nor do I know, any surgery residents who take something (other than caffeine) to stay awake. Your body learns to adjust.

The issue is more how well the rules are followed than anything else.

I've done all of residency in the post-80 hours era....and I absolutely know that working 110--120--130 hours a week can happen depending on the program and the patient acuity. Stuff happens, even with regulations in place.

 

[Winged Scapula]

Shoshu...

while there is work hour reform, some programs don't follow it and as noted above, it is an average of 80 hrs per week, so on some rotations you will work more.

My experiences are pre-work hour reform, although even after my program still had a great deal of difficulty (and still does) keeping work hours under 80.

 

[Svidrillion]

Hell Week? Apparently its "not uncommon" in the past to just do this on a regular basis for years at a time. Queers.

Oh, snap! You got me good!
It's called emperical data, Bill Nye...

Can't we all just get along? More Toadies, less inane argument.

[YOUTUBE]http://www.youtube.com/watch?v=-ZcMbhjYyUk[/YOUTUBE]

Damn I miss the 90s.

 

[SLUser11]

Damn I miss the 90s.

Me, too. I just listened to Alice In Chains Unplugged and Sublime 40 oz to Freedom back to back on a road trip, and remembered how good music inspired by heroin could be.

It sucks. People now are just doing it "for the love of the game," etc.....if they were into hard core drugs, I guarantee the Jonas Brothers would be much better....

Layne Staley and Bradley Nowell....now those guys were not quitters!


/end joke.

 

[PAgirl]

Anyone ever take Provigil to stay awake? It's approved for narcolepsy and shift work sleep disorder (or whatever it's called when you work the night shift)? I hear it works amazingly well to keep you awake and alert. Just curious.