80 Hour Work Week/work Restrictions?

[rmorelan]

Is it common that internal medicine residents (R1-R3 for the common branch) work more than 80 hours per week? It is common in all the programs across Canada??? It is more common in big programs I guess??

If I pursue internal medicine later, I would probably likely to specialize in endocrinology. So another 3 years of hard work in the road. 

 

I have only done internal medicine rotations at 3 different hospital systems and am not an internal med resident - so that does put a limit on what I can say of course From my rotations I have done they are all kind of the same really - start about 7:30 and go to about 5:30 daily 5 days a week (or in a four week block that is 200 hours - 10hr a day, 5 days, 4 weeks).

 

So that is a base of 200 hours.

 

Next there were 6 call shifts - one less than max actually, on ICU, CCU, cardiology...... there are some other blocks that are not as heavy but there are a lot of standard blocks like this. One of those days will likely be a Sat Call shift - that is a "bonus" 26-28 hours added to a work week. The other call shifts often have you getting a post call day (you get to leave by 10-11 - that cuts the work hours away from that day except for Friday as you wouldn't work the next day anyway). Do that math and you get a base of about 73 hours a week on average per 4 week block (usually there are 13 blocks a year as 13x4 is 52 weeks, and that makes things simple).

 

That assumes that you never have to stay later than 5:30 - which with discharge summaries, and tying up loose ends is probably not always true. Stuff happens.

 

Rounding down to say 70 hours as a base to be optimist. Now what we haven't talked yet about is the study time you would have to put on top of those hours - I mean you cannot just go to work of course. That would routinely take you past the 80 hour mark (and add on any research you are trying to do if you like as well).

 

So very busy services have you add another call shift to the max of 7 (like surg ones). If you don't take post call days - again as some services to despite the rules - then you are getting just that much higher.

[LittleDaisy]

Thank you for the information rmorelan. I think now that I understand why some internal residents told me that although IM is interesting and challenging, one needs to take into consideration lifestyle choice and demanding schedule. Also, one needs to apply again for CaRMS for sub-specialty match, it adds a bit more uncertainty and stress to IM.  

I was mostly thinking of 10 hours per shift and 5 days in a week (so it is not that bad IMO). Although I didn't think about calls, revision and learning time, and also research during residency

[NLengr]

Is it common that internal medicine residents (R1-R3 for the common branch) work more than 80 hours per week? It is common in all the programs across Canada??? It is more common in big programs I guess??

If I pursue internal medicine later, I would probably likely to specialize in endocrinology. So another 3 years of hard work in the road. 

They only work more than 80 hours per week because they spend 5 or 6 hours per patient debating a serum sodium value before actually doing anything........

 

/runs away giggling

[medhope15]

Is it all about not feeling competent enough to operate when you're done?

I'm a med hopeful (I have a couple of ideas of what I want to specialize in) but the thought of 80+ hour work weeks is terrifying. I mean I love med, it's why I'm trying so hard to get into it, but I also want a family which I actually see, and not be divorced after a year of school due to never being home. There has got to be a better way no? I have european family in health care; MD Is regarded as any regular job, not a million dollar salary for surgery; people aren't overworked, and patients get better. They have a 48 hour work week. They passed their exams. They feel competent. They do some surgical procedures that would be "too risky" by the standards of some Canadian docs (they see Canadian patients). So are we doing something wrong? Or is it just the north american capitalist / competitive mentality??

 

Do surgeons not feel competent at the end? That's why they push themselves into more and more OR time?

[LittleDaisy]

I think that it has to do with the high salary of MDs in North America. Also, in Canada, it is public health care, so it is entirely funded by governments. From a central government POV, it would be more economically efficient to pay a general surgeon who works around 80 hours per week. Also, after a few years of medical school, I find personally that med school has created a competitive environment. A few of med students are undergoing through a lot of personal distress due to the demanding schedule and the amount of material that one has to absorb. 

Also, it is residency, so it is a good reason to make you work more and practice more lol

Not all the specialities require 70-80 hours per week. In family, psych, some subspecialties of internal medicine are more flexible and they do have a great lifestyle.

 

If you love med, go for it. Don't think about the lifestyle for now.

 

 

Is it all about not feeling competent enough to operate when you're done?

I'm a med hopeful (I have a couple of ideas of what I want to specialize in) but the thought of 80+ hour work weeks is terrifying. I mean I love med, it's why I'm trying so hard to get into it, but I also want a family which I actually see, and not be divorced after a year of school due to never being home. There has got to be a better way no? I have european family in health care; MD Is regarded as any regular job, not a million dollar salary for surgery; people aren't overworked, and patients get better. They have a 48 hour work week. They passed their exams. They feel competent. They do some surgical procedures that would be "too risky" by the standards of some Canadian docs (they see Canadian patients). So are we doing something wrong? Or is it just the north american capitalist / competitive mentality??

 

Do surgeons not feel competent at the end? That's why they push themselves into more and more OR time?

[ploughboy]

If you love med, go for it. Don't think about the lifestyle for now.

 

Respectfully disagree.  Absolutely think about the lifestyle (and associated compromises) connected with training and practicing in your field.  And think about it even before you apply to meds.

[ellorie]

Definitely think about it.  Hard.  I knew I wanted to go into psychiatry, so I think things will generally be okay for me with respect to work-life balance when I'm done residency - but it's been a slog thus far and will likely be even more of one before I'm done.  If you're contemplating a surgical specialty, I'd think about it even harder.

[LittleDaisy]

Hey ellorie and ploughboy, thank you for your input

I haven't started my clerkship yet, so probably I am not the best person to discuss about the balance between work and personal life.

I just find that in medicine, that there are so many things to do and it is so diverse; we have such a privileged role with the vulnerable population. I am still in the honeymoon phase as a med student

For lifestyle and work schedule, I have thought about it before applying to med. I am aware that life as a doctor is not as sweet as 9-5 as most of my friends in other fields. I think that if you have good personal and family support, and learn to how to make the most of your spare time; it would help during those long calls and sleep-deprived evenings. Usually when I talked to cegep students, they all seem so hype about going into medicine; I guess that most med hopefuls only see the positive sides of medicine.

Once again, if you value highly for a normal time schedule and a good quality of life, there are always specialties that are less demanding in terms of schedule. The residency won't be the easiest in term of schedules, but there is the light at the end of tunnel 

Definitely think about it.  Hard.  I knew I wanted to go into psychiatry, so I think things will generally be okay for me with respect to work-life balance when I'm done residency - but it's been a slog thus far and will likely be even more of one before I'm done.  If you're contemplating a surgical specialty, I'd think about it even harder.

[NLengr]

Is it all about not feeling competent enough to operate when you're done?

I'm a med hopeful (I have a couple of ideas of what I want to specialize in) but the thought of 80+ hour work weeks is terrifying. I mean I love med, it's why I'm trying so hard to get into it, but I also want a family which I actually see, and not be divorced after a year of school due to never being home. There has got to be a better way no? I have european family in health care; MD Is regarded as any regular job, not a million dollar salary for surgery; people aren't overworked, and patients get better. They have a 48 hour work week. They passed their exams. They feel competent. They do some surgical procedures that would be "too risky" by the standards of some Canadian docs (they see Canadian patients). So are we doing something wrong? Or is it just the north american capitalist / competitive mentality??

 

Do surgeons not feel competent at the end? That's why they push themselves into more and more OR time?

Europeans have longer residencies than North Americans. They work less hours per week, but spend longer in residency. So it's a toss up. Residency sucks, even if the hours were less (it would just suck slightly less). I'd rather spend more time per week over a shorter amount of years.

 

I don't think you will find many surgeons who feel confident at the end of residency. They may feel they meet a minimal level of competence, but I don't know anyone who felt really comfortable operating at the start of practice. Everyone knows that, so we all try to maximize residency OR time to get as much experience as possible.  It take a good 5 years of practice before you really start to develop confidence from what most people have told me.

[plane]

Do the hours improve once you're surgical staff? Or at the very least, do you get more options in terms of the hours you work?

[ploughboy]

Hi Daisy,

 

I don't doubt your enthusiasm or sincerity.  Just wanted to provide perspective from somebody who owns a stethoscope that's almost old enough to attend highschool...

[thatonekid]

Do the hours improve once you're surgical staff? Or at the very least, do you get more options in terms of the hours you work?

 

The hours improve in that you don't have to do the majority of consults (the residents do it and you review) or you can show up a little later in the morning and leave earlier in the afternoon while the housestaff rounds on the patients. They're still long hours though, compared to other specialties, and there's all the admin work to do which you don't see as a clerk and see some of as a resident. In terms of the hours you work, some of it is dictated by whether or not you can get OR time, but sure you have some options.

[NLengr]

The hours improve in that you don't have to do the majority of consults (the residents do it and you review) or you can show up a little later in the morning and leave earlier in the afternoon while the housestaff rounds on the patients. They're still long hours though, compared to other specialties, and there's all the admin work to do which you don't see as a clerk and see some of as a resident. In terms of the hours you work, some of it is dictated by whether or not you can get OR time, but sure you have some options.

That's only true for an academic surgeon. The majority of surgeons in the country are community based. 

 

Community based surgeons still see all their own consults. However, they control when, how and who they see. If someone doesn't need a consult at 330 am, then they just tell the consulting doc they will see them the next day. If they don't need an in house consult, they may make arrangements to see the person in one of their clinics. The majority of Canadian surgeons will be seeing their own consults, it's just unlike in residency, you can control your practice and your life. Oh, and in the community, physicians actually respect their colleges in other specialties, so the pissing match academic interpersonal dynamics are much less (meaning life is much better).

 

Again, same thing for rounding. If you are in the community, you do your own rounding. However, you are only going to be rounding on your own patients, which means less people to round on. If you only have a few people admitted, you might do it between OR cases, or at lunch between clinics.

 

Additionally, in the community, the non physician staff (nurses, PT, SW etc.) take a much more active role in caring for patients, which makes your life much easier. Unlike an academic center where the answer to any question is always "Page the resident", the floor staff in the community generally make a strong effort to solve a problem prior to calling the staff.

 

The final real advantage of being staff, academic or community, is you control your own life. If you want to not book people in clinic on Friday afternoon and head out to the cottage, you can do that. If you don't want to perform a certain surgery, generally you can avoid it. Want to start clinic at 9:30 am so you can bring your kids to school? Want to only book outpatient procedures this week because you are on vacation next week? All that is possible.

 

I can't emphasize enough that what makes residency so crappy isn't the work hours. It's the complete loss of control of your own life.

[thatonekid]

^Ah, true! My post-call brain didn't even think about community practice. Thanks for the insight!

[Renin]

Hi Daisy,

 

I don't doubt your enthusiasm or sincerity.  Just wanted to provide perspective from somebody who owns a stethoscope that's almost old enough to attend highschool...

 

*chuckle*

 

Yeah, even in psychiatry, it impacts my work-life balance, and it impacts the work-life balance of my staff too. I think you should think long and hard if you want to specialize.

[amichel]

Threads like these make me panic, followed by me desperately trying to convince myself to do family medicine.  Even though I don't think I'd be happy.  Ugh.  

[thatonekid]

Threads like these make me panic, followed by me desperately trying to convince myself to do family medicine.  Even though I don't think I'd be happy.  Ugh.  

 

Don't panic and do what's best for you! It's something you'll be doing for many decades to come, you need to be happy in the specialty you choose.

[LittleDaisy]

Same here 

I think that it is important to do what you love. Because even a 9-5 family medicine clinic could be long for you, if you don't like the aspects of FM. 

Threads like these make me panic, followed by me desperately trying to convince myself to do family medicine.  Even though I don't think I'd be happy.  Ugh.