Residents in the US have 80 hours with maximum of 28 hour shifts, not a ton better. Though average salary is better at 58,000. Still, considering the hours worked and 8 years of schooling up to that point, ugh.
Residency is just a terrible idea through and through, absolutely insane. Where else could you start a job and be told “right so you’re new here, this is life and death decision making, we’d like you to stay up working for 28 hrs straight doing this. Alright, get to work!”
If a resident gets two days off, it’s called a “golden weekend.” What most people refer to as, a weekend. It’s just exploitation. Even more so when you consider Medicare pays for residents (and they even pay the hospitals more than the resident’s actual salary! So the hospital pockets that difference and benefits from all the direct value the residents generate too). There’s even an exception in US anti trust law to make the system legal. Glad more residents are unionizing here as well. Residency is horrible and needs to go.
The program, in partnership with its Sponsoring Institution, must
ensure adequate sleep facilities and safe transportation options for
residents who may be too fatigued to safely return home
So, so tired not even safe to return home (which I mean they’re right, it is not safe to be driving after staying up 24 hours straight) but continue doing patient care while you’re that impaired, it’s fine.
In a prospective study, new medical interns went from 3.9% meeting criteria for major depressive disorder to 25% after starting. And depression was linked with increased medical errors to boot. Of course mean work hours was a major association of depression too.
Totally asinine, a whole enormous meat grinding machine that needs to go, but is stuck in place by historical inertia and current profits for large hospitals.
My first year of residency (aka intern year) we were required to log our hours in an online system for purposes of compliance with the US rules you’ve outlined. During my first quarterly evaluation they pointed out that I was routinely violating work hours and that I needed to stop doing that or there would be consequences.
The implication was that I was doing something wrong and trying to work more than 80 hours a week.
In reality I was a completely powerless individual and I routinely had a ton of work dumped on me that took more time than was allotted. By framing it as my problem they made it quite clear: they had no intention of following the rules and I had better falsify my time-keeping records or face consequences.
Unfortunately a common experience. While they don’t tell you to lie, the system is set up to make that the only reasonable option. And even if they were holding to 80 hour max (open secret this limit is broken many places) it would still be too much for any job, let alone something high risk like a doctor in training. If you were on a plane with a pilot in training who’d worked almost 80 hrs and been up for 20 hours straight already, you’d rightfully be very concerned.
Don’t forget mandatory resiliency lectures after your 24 hr shift to really rub it in and gaslight you that all of this is somehow your fault.
Well, in a good organisation this would be an important lesson: you need to signal when you can’t get more work done. Whether it’s sheer time pressure, contacts, or legal issues, or whatever. Every worker needs to immediately bring up obstacles to their work. It’s up to managers/supervisors to find solutions. That’s their number one job.
The problem is there is no recourse like in a normal job. It’s not like you can just say, working conditions here are bad I’m going somewhere else. Working conditions are miserable everywhere for residents, 80 hour weeks are a norm not an exception, and switching to other programs is near impossible. There’s a specific exception in US anti trust law that helps keep this all going and make it so programs effectively don’t need to compete with each other on things like pay and benefits. If a resident were to leave their program, they’d be saddled with 6 figure student loan debt, be unable to use their degree for the most part, and be very unlikely to be picked up by any other program. And if they did, it’d likely be an even worse situation (why else would the position be open?). Though some programs may be better than others, even the best case scenarios are ridiculous and unsafe to any reasonable person looking at them. It’s this bizarre case of group insanity where people figure it must be reasonable if so many people put up with it, but anyone outside of medicine would be horrified. The entire residency system is broken, has been from the start, and all the external incentives on the residency system are pushing it to get even worse, not better. Need change forced by law from above, the monopoly ended, or resident unions, all three really.
I understand the sentiment but it’s not really helpful. They’re still the ones on call, they need to talk to you, and will be writing your orders and things anyways. Not really like they can just say, oh yeah I am tired I’ll just go home and sleep and abandon all these patients here, why didn’t I think of that?
Helpful things would be writing congressmen and senators about reform to the residency system, supporting unionization efforts. Change will only come if forced from above or if residents get more of a say. Ideal situation in my mind would be a more typical work schedule capped at closer to 50 hours a week, maybe with increased residency training time overall and increased pay during that time to compensate (need to keep up with cripplingly high student loan debt for those who didn’t have wealthy parents who payed for medical school).
Even attending physicians will really need to start unionizing if they don’t want to get totally lost in the shuffle, since they’re mostly employed directly now instead of running their own practices or specialty group, they get very little say in how things are done.
I’m imagining that I might just leave and try either a different place, or treat it myself. One can’t blame a doctor for “choosing” to be up so long that they’ll make an understandable but deadly mistake.
Residents in the US have 80 hours with maximum of 28 hour shifts, not a ton better. Though average salary is better at 58,000. Still, considering the hours worked and 8 years of schooling up to that point, ugh.
Residency is just a terrible idea through and through, absolutely insane. Where else could you start a job and be told “right so you’re new here, this is life and death decision making, we’d like you to stay up working for 28 hrs straight doing this. Alright, get to work!”
If a resident gets two days off, it’s called a “golden weekend.” What most people refer to as, a weekend. It’s just exploitation. Even more so when you consider Medicare pays for residents (and they even pay the hospitals more than the resident’s actual salary! So the hospital pockets that difference and benefits from all the direct value the residents generate too). There’s even an exception in US anti trust law to make the system legal. Glad more residents are unionizing here as well. Residency is horrible and needs to go.
https://www.acgme.org/globalassets/pfassets/programrequirements/cprresidency_2023.pdf
There’s even this lovely line:
So, so tired not even safe to return home (which I mean they’re right, it is not safe to be driving after staying up 24 hours straight) but continue doing patient care while you’re that impaired, it’s fine.
In a prospective study, new medical interns went from 3.9% meeting criteria for major depressive disorder to 25% after starting. And depression was linked with increased medical errors to boot. Of course mean work hours was a major association of depression too.
https://jamanetwork.com/journals/jamapsychiatry/article-abstract/210823
Totally asinine, a whole enormous meat grinding machine that needs to go, but is stuck in place by historical inertia and current profits for large hospitals.
My first year of residency (aka intern year) we were required to log our hours in an online system for purposes of compliance with the US rules you’ve outlined. During my first quarterly evaluation they pointed out that I was routinely violating work hours and that I needed to stop doing that or there would be consequences.
The implication was that I was doing something wrong and trying to work more than 80 hours a week.
In reality I was a completely powerless individual and I routinely had a ton of work dumped on me that took more time than was allotted. By framing it as my problem they made it quite clear: they had no intention of following the rules and I had better falsify my time-keeping records or face consequences.
Unfortunately a common experience. While they don’t tell you to lie, the system is set up to make that the only reasonable option. And even if they were holding to 80 hour max (open secret this limit is broken many places) it would still be too much for any job, let alone something high risk like a doctor in training. If you were on a plane with a pilot in training who’d worked almost 80 hrs and been up for 20 hours straight already, you’d rightfully be very concerned.
Don’t forget mandatory resiliency lectures after your 24 hr shift to really rub it in and gaslight you that all of this is somehow your fault.
Well, in a good organisation this would be an important lesson: you need to signal when you can’t get more work done. Whether it’s sheer time pressure, contacts, or legal issues, or whatever. Every worker needs to immediately bring up obstacles to their work. It’s up to managers/supervisors to find solutions. That’s their number one job.
The problem is there is no recourse like in a normal job. It’s not like you can just say, working conditions here are bad I’m going somewhere else. Working conditions are miserable everywhere for residents, 80 hour weeks are a norm not an exception, and switching to other programs is near impossible. There’s a specific exception in US anti trust law that helps keep this all going and make it so programs effectively don’t need to compete with each other on things like pay and benefits. If a resident were to leave their program, they’d be saddled with 6 figure student loan debt, be unable to use their degree for the most part, and be very unlikely to be picked up by any other program. And if they did, it’d likely be an even worse situation (why else would the position be open?). Though some programs may be better than others, even the best case scenarios are ridiculous and unsafe to any reasonable person looking at them. It’s this bizarre case of group insanity where people figure it must be reasonable if so many people put up with it, but anyone outside of medicine would be horrified. The entire residency system is broken, has been from the start, and all the external incentives on the residency system are pushing it to get even worse, not better. Need change forced by law from above, the monopoly ended, or resident unions, all three really.
Is it rude to start asking them how long they’ve been up? I don’t even want medical advice from someone who’s been up 28 hours.
I understand the sentiment but it’s not really helpful. They’re still the ones on call, they need to talk to you, and will be writing your orders and things anyways. Not really like they can just say, oh yeah I am tired I’ll just go home and sleep and abandon all these patients here, why didn’t I think of that?
Helpful things would be writing congressmen and senators about reform to the residency system, supporting unionization efforts. Change will only come if forced from above or if residents get more of a say. Ideal situation in my mind would be a more typical work schedule capped at closer to 50 hours a week, maybe with increased residency training time overall and increased pay during that time to compensate (need to keep up with cripplingly high student loan debt for those who didn’t have wealthy parents who payed for medical school).
Even attending physicians will really need to start unionizing if they don’t want to get totally lost in the shuffle, since they’re mostly employed directly now instead of running their own practices or specialty group, they get very little say in how things are done.
I’m imagining that I might just leave and try either a different place, or treat it myself. One can’t blame a doctor for “choosing” to be up so long that they’ll make an understandable but deadly mistake.