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IB885588 | 7 years ago

Peter Attia (MD) had a podcast episode where he talked about being a resident and how it almost killed him (asleep while driving) and was bad for patient.

Also explained that the guy who created the residency program was a cocaine addict who rarely slept, and since then all doctors have to try to follow his crazy schedule for no good reason..

discuss

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pc86|7 years ago

My girlfriend is a second-year OB/GYN resident (which is a 4 year program) and while that field's residency is less insane than some other specialties like ER, she still works 12 hour shifts Mon-Fri (6a-6p on paper but generally 6-7:30), one 24-hour weekend shift a month, and one 12-hour weekend free clinic shift a month. This is on top of the "extras" that are not work but are required to graduate the residency programs. Weekly rotating presentations to the rest of her group (4 other second-year residents so one ~45 minute presentation every 4 weeks), research, generally keeping up with the state of the art in her field, etc.

So she's only "scheduled" for ~67 hours a week averaged throughout the month, but realistically it is in the 85-90 range.

It's easy to see how a more demanding or emergent field could seriously select for folks who are more able or willing to work on less sleep.

ineedasername|7 years ago

Yeah. I mean, I get that hospitals are 24-hour operations that need doctors & nurses available at all times. So some people are going to get the crap end of that stick and have to do night shifts. But is it really necessary for them to work 80+ hours while they're at it? It seems like there's enough people trying to be doctors that you could cut that down to a healthier 40 hours+ 15 hours on call if it's really necessary to. Heck, even 50 hours.

cstross|7 years ago

Here in the UK, the way I heard it from a friend who was doing their pre-med, is that there was a built-in cost incentive: hospitals paid doctors who were on-call at one third of their regular hourly rate for out-of-hours on-call coverage. (That's not regular hourly rate plus a third; that's one third of normal wages for hours after the first 40.) So the hospital administration had a solid reason to work their interns and house officers into the ground rather than hiring extra junior doctors.

The original rationale was that the "on call" hours were not supposed to be busy and the duty doctors could spend most of them sleeping in a bunk or studying: but by the late 1980s (when I heard about things) they were working more or less constantly through their shifts.

The EU Working Hours Directive was supposed to fix this by banning workers from putting in more than about 50 hours a week without very specific protections being enforced, but one of the first things the UK's Conservative government did in 2010 was to stop enforcing this.

esm|7 years ago

The counter argument that I have heard is that patient handoffs are where a disproportionate number of errors occur. Increasing the number of shifts means that more patients in the ED or on the floor will have care fragmented between providers, making it more likely that results will not be followed up or that changes in a patient's status will not be recognized.

I don't know at what point the errors from sleep deprivation exceed the errors from patient handoffs. People seem to take different views depending on what side of the work hours debate they fall on.

pc86|7 years ago

You would likely have to extend residency based on everything that you need to learn for a given specialty. Med school graduates have an average of over $180k in student loan debt - from med school alone - and resident salaries in the 2-4 year programs are mid five figures.

Given the choice, I'm not sure someone whose 4-year earning potential is capped at $60k with $200k in student loans would want to extend that to 5/6/7 years.