a reasonable residency schedule?

[craig]

I was horrified to just read some posts and learn that residents, at least first-year ones, work straight through for 30 hours in a row at 4-day intervals. This is apparently an improvement on the recent situation which has been imposed by legislation. I cannot imagine a valid justification for this type of schedule unless there is a critical shortage of physicians, which I do not believe is the case. I recognize the need for doctors to work graveyard shifts, but this should be able to be scheduled without skipping sleep. Studies have shown significant harm to health parameters due to sleep deprivation, especially on a chronic basis. Reduction of sleep to 6 hours/night is bad enough to significantly raise inflammatory markers in the body. Mice deprived of sleep had less resistance to cancer growing in their bodies.

Does anyone know of a residency program where such a burdensome schedule is not necessary and full sleep is allowed for? What is the residency work schedule like in the 2nd and 3rd years? I am 50, but was all gung ho to become a physician until I read about this horrendous schedule. Is there any way that I could find a program which would make allowances for people of my age? We recover less quickly than the youngsters.

[stephew]

the problem is not just mere hours in a row but work load. I held 22 patients once and noting but the fact that they were all vets who live no matter what you do kept them afloat. Intership is hard period.

[helpfulgrad]

Hi there...
The amount of hours that residents work and the compensation we get has been an issue that's been evolving over the years and culminated with some national rules by the ACGME. Examples of these rules include 1) capping the # of hours worked each week at 80 2) ensuring that each resident gets at least 10 hrs off between shifts 3) capping the amount of patients that interns take care of etc etc...
I have to say that these rules have definitely made life easier for many of us still pluggin through resident life. However, many programs still disobey the rules as long as they don't get caught and life can still be very tough. That being said, life as a resident really varies amongst the specialties. For example, your life is quite easy as a dermatology or radiology resident but can be very tough and disenchanting as a surgery or medicine resident.
Some programs have implemented measures to meet the rules of the ACGME. For example, programs that did not previously have a night float system have now instituted them. Previously residents would take call overnight and end up staying the next day until after 12pm to complete work (thereby doing 30-hr shifts etc). With night float, residents take call until 9 or 10 pm and then go home leaving the night's work in the hands of the night float team. They are then expected back in the morning for a new day's work.
Whether this really helps or not is variable and some residents prefer the old system of overnight call with the post-call day off. Anyways, to make a long story short... life as a resident is generally tough but really varies depending on the program you're in and how pro-active they are for their residents.
Any specific questions... ask....
HG

[craig]

If anyone prefers to go overnight, it is likely because they are ignorant of what it does to them. Do you mean that with the night float system, residents always get to go home by 10pm and never have to work overnight? Would this mean that the longest shift would be around 14 hours?

I was thinking of internal medicine or family practice because of my age and the shorter residency requirements for board certification. Also, I thought these might relate to medical research which I also want to do, better than some of the other areas. Are there a large number of residency programs with the night float system now? Do things ease up at all in the 2nd and 3rd years?

[teratos]

My old program now has a float system. When you are on the floor, the longest shif you will work is 15 hrs. They usually get out by 10PM. They still do overnights in the unit, but are out by 26 hrs. G

[microphage]

Originally Posted by teratos

My old program now has a float system. When you are on the floor, the longest shif you will work is 15 hrs. They usually get out by 10PM. They still do overnights in the unit, but are out by 26 hrs. G

So how many of those hours do you usually get to "sleep"?

[helpfulgrad]

I understand your concerns.. and will try to address them. I cannot of course make generalizations about programs since I dont know how specific programs operate nor have I researched this. I will speak about my own program and by extension some of the other programs in the northeast since they seem to operate on a fairly similar basis.
If you want, you can go to the websites for the specific program(s) that you are considering and look for information. Many of these websites now have a page dedicated to what the "typical" day is like and how they operate their other shifts - night float, units etc.
At my program, life was quite hectic. However, the powers that be (program director, chairman, chief residents) have implemented some helpful systems. We rotate at 3 hospitals during our residency training. At all 3 of these there is a night float team. The night float team comes at 8pm or 9pm (at the VA hospital). This means that the on-call team stops (cross)-covering the wards from 8 or 9pm onward. The on-call team is also supposed to leave the ward at that time. However, depending on how busy the call is, you may end up leaving around 10pm. If there is a patient crashing, obviously the right thing to do is not to just hand over to the night float as soon as they come in, but to stay and help out while the pt is stabilized. We are on call every 4th day.
Therefore, on average when you're on the wards, and on call, you will leave around 9 or 10pm every 4th day. On regular (non-call) days you will leave between 4pm and 5pm. Now this does not mean that we never work overnight. What it does mean is that we work a max of 14-15hrs when we're on call.
When we do our ICU or CCU months we do a 24-hr call every 3 days. This is the hardest of all our months. The call is usually busy and we're up for 27 hrs at a time usually. The chiefs are very good about getting us out on time post-call. So to answer your question, you will more than likely still have to do overnight shifts. Also, we all have to do at least 1 month of night float which is the overnight shift.
So to recap, when we're on wards we do call every 4th day until 9 - 10pm (no overnight). When we're on ICU/CCU we do call every 3rd day (overnight). When we're on night float - it's obviously an overnight shift. In general, for your first year you'll have 1-2 unit months and 1-2 night float so max 4 months of overnight but it can be as little as 2 months of overnight.
Does life get easier as you progress? The answer is yes. As a 2nd yr or 3rd yr your ward duties are much less. In other words, you would do about 5 months of wards during first yr but 3-4 during 2nd yr and currently our 3rd years do 2 months of wards. In addition, 1st yrs get no elective time, 2nd yrs get 3 months electives and 3rd yrs get 4 months electives. So life does get easier. Thats the good thing about a medicine residency. The more senior you get, the easier life gets. This is not the case everywhere you go but it's generally true. In surgery and ob/gyn...life does not get easier.
In terms of your choice of specialty, i think thats something for you to decide. IM and FP can both be very rewarding but you have to decide which one suits you better and what you'd rather be doing. If you want to see a wide spectrum of patients - peds, ob etc then go FP. Anyone can do research really, so dont sweat it. Research is not limited to a specialty.

Sorry this is a bit long... but hope it helps...
any other questions... feel free to ask....
HG

[teratos]

On the long-call (which would be the longest shift you have under our system) you should be able to get 6 hours of solid, uninterrupted sleep that night.

We had a similar schedule as helpfulgrad in the units. Every 3rd night you were on call and in-house. often people are up all night.

This is much better than the old schedule. We used to be on call, in-house, every 4th night on the floors. When on call you were up all night most nights. Maybe an hour or so of sleep if you were lucky. In the units it was every third night. On-call meant a 36 hour shift. Fun, fun, fun. Luckily I was too tired to remember any of that misery. G

[microphage]

Originally Posted by teratos

On the long-call (which would be the longest shift you have under our system) you should be able to get 6 hours of solid, uninterrupted sleep that night.

We had a similar schedule as helpfulgrad in the units. Every 3rd night you were on call and in-house. often people are up all night.

This is much better than the old schedule. We used to be on call, in-house, every 4th night on the floors. When on call you were up all night most nights. Maybe an hour or so of sleep if you were lucky. In the units it was every third night. On-call meant a 36 hour shift. Fun, fun, fun. Luckily I was too tired to remember any of that misery. G

The thought of not being able to get a good night's rest is just frightening to me. I'm usually the grumpiest guy around when I don't get more than 5-6 hours to zzzzzzs..... You wouldn't wanna see me with just an hour's sleep....