Working hours during residency

[ProteinTreasure]

Hello everyone!

I don't see a recent thread on working hours during residency. Please share your experience on how you juggle long shifts and personal life. I'd like to find out which residency programs have relatively short working hours.

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[Winged Scapula]

Given that there are over a thousand residency programs in the US, in many different specialties and geographic areas, perhaps you could make the task you've entrusted the SDN to do for you a tad easier by telling us what field you are applying to and where in the country you would like to be/need to be.

 

[Arcan57]

So, can you tell me about stuff?

 

[Winged Scapula]

So, can you tell me about stuff?

I think users could reasonably comment on how to balance residency and a personal life but more information is required to answer the OPs query about which residency programs have a short hours.

 

[ProteinTreasure]

Thank you for the comments! I am interested in pursuing a nonsurgical specialty. I am still undecided, but most probably it will be internal medicine.

 

[MediCane2006]

Given that there are over a thousand residency programs in the US, in many different specialties and geographic areas, perhaps you could make the task you've entrusted the SDN to do for you a tad easier by telling us what field you are applying to and where in the country you would like to be/need to be.

...and this is why we you WS

 

[Law2Doc]

Thank you for the comments! I am interested in pursuing a nonsurgical specialty. I am still undecided, but most probably it will be internal medicine.

Again there's a range both regionally and depending on what rotations you are on, whether we are talking about a big program or small, academic versus community, benign versus malignant, etc. You could be working 75-80 hours a week for an ICU month and perhaps as light as 50-55 hours a week on a lighter elective month. There are programs where the hours are rougher than others. All you really know is duty hour caps, which programs, at least on paper, need to follow. This is the kind of question you really need to quietly ask residents at various programs when you get to the point of actually interviewing. Asking it broadly and on a national basis which lumps too many different variations won't be useful for you. What if some guy at a community program in State A says it's a chill 50 hours a week, but you end up going to an understaffed academic program in State B where you rarely have a month in actual compliance with the duty hours. how does this help you?

 

[Bartelby]

Hello everyone!

I don't see a recent thread on working hours during residency. Please share your experience on how you juggle long shifts and personal life. I'd like to find out which residency programs have relatively short working hours.

When on a long hours rotation the 'juggling' of long shifts and personal life takes care of itself. You have time to do basic personal hygiene, maybe exercise, do chores like laundry/cooking/grocery shopping, and then on your one day off you should try to schedule in time with your significant other, or with friends, or doing hobbies you enjoy. You will probably watch a little TV or read with some of your weekday off time (and your one day working on the weekned I lump in with this). You will have very little time, though, and likely will spend a lot of it doing chores. It's not the most pleasant existence.

IM tends to have long hours, at least in any setting I have seen. By long I mean wards will usually start quite early and push 80 hours per week. By reputation psychiatry, PM&R, and emergency medicine may have shorter hours depending on the program. For most specialties you will still have to do a full intern year though (psych is more like 6 months medicine + neuro with the rest psych and pathology does not do a traditional intern year).

 

[Law2Doc]

... By reputation psychiatry, PM&R, and emergency medicine may have shorter hours depending on the program. For most specialties you will still have to do a full intern year though (psych is more like 6 months medicine + neuro with the rest psych and pathology does not do a traditional intern year).

PM&R requires a prelim year, and since it's typically the least competitive of the "advanced" specialties, you wouldn't bank on a cushy transitional year.

 

[cabinbuilder]

My residency morning report started at 7:30 am. I was usually home by 5:30-6pm depending on the rotation and whether if clinic ran over. Of course for us hospitalist rotation was the busiest since we had no admit cap and took everyone who came through the ER. We had medicine almost every other month so on the "free time" during the other rotations we would work on discharge summaries and getting dictations caught up and medical records signed. That can be a huge task coming off medicine with 40+ dictations still to do. I don't think I ever worked over 60 hours in a week and usually it was just like a regular 40 hour job.

 

[Dr. USMLE]

While the ROAD specialties are prolly accurate, the surgical specialties prolly work more than those numbers and neurosurg and ortho have extended caps to 88 hours/week. To make it worse, programs are allowed a 10% variation...so a neurosurg or ortho resident could work 95 hours a week and still be in compliance with the ACGME. Most surgery residents I have encountered at a number of institutitions have told me they are coerced to fabricate hours to be in compliance. With the widespread use of EMR, I am a bit surprised the ACGME doesn't just look up when orders were placed to determine how long a resident is actually in the hospital.

 

[rads2k13]

I agree. If the program is not supportive of these new restrictions, then the pressure is put on the residents. Self-reporting has to be taken with a big grain of salt. Relatively speaking, I think the list is accurate. I am not surprised that Neurosurgery has more work hours than anyone else.

 

[Winged Scapula]

While the ROAD specialties are prolly accurate, the surgical specialties prolly work more than those numbers and neurosurg and ortho have extended caps to 88 hours/week. To make it worse, programs are allowed a 10% variation...so a neurosurg or ortho resident could work 95 hours a week and still be in compliance with the ACGME. Most surgery residents I have encountered at a number of institutitions have told me they are coerced to fabricate hours to be in compliance. With the widespread use of EMR, I am a bit surprised the ACGME doesn't just look up when orders were placed to determine how long a resident is actually in the hospital.

Actually the 10% exception IS the 88 hours (that is 10% beyond the usual 80); programs are not granted any extension beyond that by RRC/ACGME:

"Can duty hours for surgical chief residents be extended to 88 hours per week?"
Programs interested in extending the duty hours for their chief residents can use the “88- hour exception” to request an increase of up to 10% in duty hours on a program-by- program basis, with endorsement of the sponsoring institution’s graduate medical education committee (GMEC) and the approval of the Review Committee. If approved, the maximum duration of the approval may not exceed the length of time until the program’s next site visit and review. A request for an exception must be based on a sound educational justification. Most Review Committees categorically do not permit programs to use the 10% exception. Neurological Surgery and Orthopaedic Surgery are the only Review Committees that allow exceptions.

 

[Dr. USMLE]

Actually the 10% exception IS the 88 hours (that is 10% beyond the usual 80); programs are not granted any extension beyond that by RRC/ACGME:

"Can duty hours for surgical chief residents be extended to 88 hours per week?"
Programs interested in extending the duty hours for their chief residents can use the “88- hour exception” to request an increase of up to 10% in duty hours on a program-by- program basis, with endorsement of the sponsoring institution’s graduate medical education committee (GMEC) and the approval of the Review Committee. If approved, the maximum duration of the approval may not exceed the length of time until the program’s next site visit and review. A request for an exception must be based on a sound educational justification. Most Review Committees categorically do not permit programs to use the 10% exception. Neurological Surgery and Orthopaedic Surgery are the only Review Committees that allow exceptions.

I stand corrected. But I think we both know that all of that is BS anyway. So flagrant are the work hour violations that it must be that the ACGME simply looks the other way. I know about a dozen Neurosurg residents...not a single one of them works less than 88 hours a week. My ortho friends tell me they routinely work >100 hrs/wk on trauma. Gen Surg is the same...hardly any residents (not a single one that I know) are working less than 80 hrs/wk.

 

[Winged Scapula]

I stand corrected. But I think we both know that all of that is BS anyway. So flagrant are the work hour violations that it must be that the ACGME simply looks the other way. I know about a dozen Neurosurg residents...not a single one of them works less than 88 hours a week. My ortho friends tell me they routinely work >100 hrs/wk on trauma. Gen Surg is the same...hardly any residents (not a single one that I know) are working less than 80 hrs/wk.

Absolutely. You will get no argument from me there.

 

[Law2Doc]

I stand corrected. But I think we both know that all of that is BS anyway. So flagrant are the work hour violations that it must be that the ACGME simply looks the other way....

Well, they don't "look the other way", they just lack the ability to ferret out facts, absent a disgruntled whistleblower. Programs give the ACGME periodic documentation which demonstrates that residents are in compliance. The work schedules are all created such that shifts "should" be done within the 80 hour limit. They have the residents sign duty hour sheets that document the hours they claim they worked. The residents are surveyed periodically and their responses don't usually indicate duty hour problems. The ACGME periodically does spot checks and interviews residents who inevitably claim everything is fine. Not much more the ACGME is going to be able to do -- they don't have the resources to monitor the comings and goings of specific residents over a four week block to see if they are exceeding an 80 hour average, and residents don't punch time cards at most places. So they just sit tight and wait for disgruntled employees to report violations, at which point they "investigate". And given the cultures of certain specialties, whistle blowing rarely happens.

 

[Stellar Clouds]

With the widespread use of EMR, I am a bit surprised the ACGME doesn't just look up when orders were placed to determine how long a resident is actually in the hospital.

I have heard of an ortho program getting busted because the ACGME checked the parking cards of the residents to see when they went in and out of the parking garage.

 

[Law2Doc]

I have heard of an ortho program getting busted because the ACGME checked the parking cards of the residents to see when they went in and out of the parking garage.

That doesn't sound likely. Plus some residents just use a hospital lot as a spare covered parking spot and walk. The fact that my car hasn't moved in three months doesn't really mean I never left the building. There would have to be more evidence.

 

[Stellar Clouds]

That doesn't sound likely. Plus some residents just use a hospital lot as a spare covered parking spot and walk. The fact that my car hasn't moved in three months doesn't really mean I never left the building. There would have to be more evidence.

It seems to me that it would be quite obvious to tell the difference between a resident having his car in the parking garage for 744 hours straight versus the majority of residents in a program having logged 350-400+ hours with roughly 12-24 hour blocks in the garage over the course of a month.

 

[Law2Doc]

It seems to me that it would be quite obvious to tell the difference between a resident having his car in the parking garage for 744 hours straight versus the majority of residents in a program having logged 350-400+ hours with roughly 12-24 hour blocks in the garage over the course of a month.

It's maybe enough to be suspicious but still not solid enough evidence to make an accusation.

 

[Bartelby]

It's maybe enough to be suspicious but still not solid enough evidence to make an accusation.

This is true, I sometimes use my parking on my off days because the garage is close to things I want to go do. It would make it look like I came in an extra day that week.

 

[45408]

It seems to me that it would be quite obvious to tell the difference between a resident having his car in the parking garage for 744 hours straight versus the majority of residents in a program having logged 350-400+ hours with roughly 12-24 hour blocks in the garage over the course of a month.

What if someone takes a 3 hour nap when they're post-call, so that they don't drive home while they're exhausted? Their timecard would look like they stayed and worked that whole time. I've heard this story too, but no one ever mentions where it happened.

 

[Stellar Clouds]

What if someone takes a 3 hour nap when they're post-call, so that they don't drive home while they're exhausted? Their timecard would look like they stayed and worked that whole time. I've heard this story too, but no one ever mentions where it happened.

I think you can appreciate the difference between a few residents sporadically having aberrant hours 1 or 2 months out of the year from the majority of residents in a program going over hours the majority of months in a year.

How many times have you actually slept at the hospital post-call, instead of sleepily driving yourself home to your much more comfortable bed?

 

[Law2Doc]

I think you can appreciate the difference between a few residents sporadically having aberrant hours 1 or 2 months out of the year from the majority of residents in a program going over hours the majority of months in a year.

How many times have you actually slept at the hospital post-call, instead of sleepily driving yourself home to your much more comfortable bed?

I cant tell you what interns do now, but lot of us used to take naps at the end of call back when it was 30 hours. It can be dangerous to drive home if youve been up that long. Or maybe you have kids at home and won't get any sleep if you go there. Or maybe you use the gym/pool on campus before/after work and so your car is sitting there a few hours every day while you aren't even in the hospital? Too many variables, too little hard evidence. It's a Bogus story.

 

[NotAProgDirector]

The ACGME does not check parking time stamps. This is crazy talk.

Is is possible that a program might do so internally as a quick-and-easy-but-really-inaccurate-and-prone-to-errors way of doing it? Sure. With all the caveats in this thread.

 

[45408]

I think you can appreciate the difference between a few residents sporadically having aberrant hours 1 or 2 months out of the year from the majority of residents in a program going over hours the majority of months in a year.

How many times have you actually slept at the hospital post-call, instead of sleepily driving yourself home to your much more comfortable bed?

It takes me about as long to drive home as it does to walk to the call room.

Look, I know that programs violate work hours, but do you have any proof that these parking lot cards have ever actually been checked?

 

[Buzz Me]

How many times have you actually slept at the hospital post-call, instead of sleepily driving yourself home to your much more comfortable bed?

After really busy overnight calls? One three-month stretch I napped in the call room EVERY SINGLE POST-CALL DAY.

Of course my "post-call" day usually ended around 5-6 pm.

 

[blue2000]

I rarely slept in the hospital post call, but semi-regularly I'd leave my car in the garage, and take an 8 dollar cab ride home because I thought it was unsafe to drive. More than once, the cabbie had to wake me up when we arrived (I lived like 2 miles from the hospital).

 

[Bostonredsox]

The ACGME does not check parking time stamps. This is crazy talk.

Is is possible that a program might do so internally as a quick-and-easy-but-really-inaccurate-and-prone-to-errors way of doing it? Sure. With all the caveats in this thread.

Our hospital is all cpoe now. Notes are computer meditech based and have time stamps. All orders are cpoe and time stamped. Unless you are here early seeing patients or something similar that requires no ordering or documenting its getting harder to violate hours