What’s maximum number of hours that clinical clerk can work per week?

[Bookmark311]

Is it 80 hours? Is there a maximum? Or can school work students for 80+ hours?

[bread]

Our school states our max is 55/week, NOT including call (so potentially on busy services like surgery, you could end up with 90 if you had 2 calls in one week).  That being said, it's much less on a lot of services, thankfully.  I would estimate that my average has been about 50 hours/week over the course of clerkship 

[bellejolie]

ours is 72 max including call. no more than 16 h a day in quebec.

[JohnGrisham]

12 hours ago, bread said:

Our school states our max is 55/week, NOT including call (so potentially on busy services like surgery, you could end up with 90 if you had 2 calls in one week).  That being said, it's much less on a lot of services, thankfully.  I would estimate that my average has been about 50 hours/week over the course of clerkship 

Despite this, most medical students will not actually be hitting anywhere near 90hrs of "work". Most services, even with a 24-26hr call shift, will not have medical clerks doing work consistently throughout the time...and they will get sleep/downtime. With post-call day.      There's been shifts over the last 5 years to try to ensure everyone is on the same page re: clerks.    When i was a resident on my surgical rotation(been a while now), the medical students slept overnight usually. Residents can simply do anything a med student can much quicker, especially at night.  

It isn't pleasent to have to be onsite overnight, and the sleep you do get is usually not restful out of fear of having to be paged.  

[bread]

13 minutes ago, JohnGrisham said:

Despite this, most medical students will not actually be hitting anywhere near 90hrs of "work". Most services, even with a 24-26hr call shift, will not have medical clerks doing work consistently throughout the time...and they will get sleep/downtime. With post-call day.      There's been shifts over the last 5 years to try to ensure everyone is on the same page re: clerks.    When i was a resident on my surgical rotation(been a while now), the medical students slept overnight usually. Residents can simply do anything a med student can much quicker, especially at night.  

It isn't pleasent to have to be onsite overnight, and the sleep you do get is usually not restful out of fear of having to be paged.  

Yes, I agree! On surgery and OBGYN, I think I usually averaged around 2-4 hours of sleep on call shifts. Internal and peds around 4-6ish I think.

[bearded frog]

I usually don't wake clerks up once they go to bed, unless I have 4 admissions at once or something and the junior and I are both going to be occupied for the next 1+ hour. If I'm trying to go back to bed i can usually complete an admission in 20-40 mins but obviously it will be understandably longer if the clerk does it then reviews it etc. and there's not a lot of great teaching that goes on at 4 am. I personally think call for clerks on our service should be until 11 pm universally, as I think the days are more valuable (and usually before 11 because I'm not going to have them start doing an admission after 9:30).

[bellejolie]

13 minutes ago, bearded frog said:

I usually don't wake clerks up once they go to bed, unless I have 4 admissions at once or something and the junior and I are both going to be occupied for the next 1+ hour. If I'm trying to go back to bed i can usually complete an admission in 20-40 mins but obviously it will be understandably longer if the clerk does it then reviews it etc. and there's not a lot of great teaching that goes on at 4 am. I personally think call for clerks on our service should be until 11 pm universally, as I think the days are more valuable (and usually before 11 because I'm not going to have them start doing an admission after 9:30).

Agree 100% that’s how we do it and it’s much better. One overnight I had in Peds and there wasn’t much. But the good thing in Quebec is people on night float just do night float so they’re awake and actually pretty into teaching which is nice. 

[bearded frog]

1 hour ago, bellejolie said:

Agree 100% that’s how we do it and it’s much better. One overnight I had in Peds and there wasn’t much. But the good thing in Quebec is people on night float just do night float so they’re awake and actually pretty into teaching which is nice. 

we have night float too but we sleep still occasionally!

[bellejolie]

1 minute ago, bearded frog said:

we have night float too but we sleep still occasionally!

Yes of course but Quebec doesn’t have 24 hour call and honestly it makes a big difference. 

[1D7]

I don't think there was an actual hour limit where I went (though you couldn't do call more frequently than what residents did). Overall I averaged ~70 hours on busy surgical rotations rotations and ~45 hours on more chill outpatient rotations. The absolute worst were 90 hour weeks, which were rare (this is all including call).

On both IM and surgery I probably averaged 2-3 hours of sleep or so. OB 4-6 hours (usually because they didn't page you).

In retrospect being worked hard was valuable in that there were no illusions as to how difficult residency would be. I feel bad for people who are shielded from the realities of tough specialties and end up disliking it later on.

[bellejolie]

36 minutes ago, 1D7 said:

I don't think there was an actual hour limit where I went (though you couldn't do call more frequently than what residents did). Overall I averaged ~70 hours on busy surgical rotations rotations and ~45 hours on more chill outpatient rotations. The absolute worst were 90 hour weeks, which were rare (this is all including call).

On both IM and surgery I probably averaged 2-3 hours of sleep or so. OB 4-6 hours (usually because they didn't page you).

In retrospect being worked hard was valuable in that there were no illusions as to how difficult residency would be. I feel bad for people who are shielded from the realities of tough specialties and end up disliking it later on.

That I definitely agree with. I think many don’t realize that training as a med student in certain specialties is really different than being a resident and certainly go on to be miserable. But I feel you can gauge if you’re insightful, how tired and miserable the residents are when you rotate with them and see. Also useful for job opportunities and future stuff. For example I have a friend who’s applying to a surgical specialty who is questioning it now because of the hardships she’s hearing one of her close friends deal with as an r2, and because she knows an r4 in the same specialty who literally can’t get a job less than 6 hours outside the city. Makes you think twice. 

[birdy21]

My school has a max of 55 hours per week, not including call. I think the worst week I've ever had was over 90 hours on internal medicine with 3 x 26 hour call in one week plus a few long days. Sleep is also pretty variable, I did have two call shifts on internal med where I did not even see the inside of my call room the whole night. As much as this sucks, I do agree that it's useful in the fact that you know what you're getting into if you go into IM/surg etc. Although having three 26 hr call shifts in one week was a little overboard 

[Egg_McMuffin]

6 hours ago, birdy21 said:

My school has a max of 55 hours per week, not including call. I think the worst week I've ever had was over 90 hours on internal medicine with 3 x 26 hour call in one week plus a few long days. Sleep is also pretty variable, I did have two call shifts on internal med where I did not even see the inside of my call room the whole night. As much as this sucks, I do agree that it's useful in the fact that you know what you're getting into if you go into IM/surg etc. Although having three 26 hr call shifts in one week was a little overboard 

That's a lot of calls for a clerk. At my school we get 1 call per week for IM. I agree that they are very busy though. Sleeping 2-3 hours is an exception. 

If you do calls don't you get the next day off though? I'm curious how it adds up to 90 hours.

[neurologist19]

I doubt anyone is capable of working 80 hours a week. If so many medical students can graduate from the medical school no problem, it means it is not 80 hours actual work... or whatever it is, it is manageable. People on forums like exaggerate things

[robclem21]

1 hour ago, neurologist19 said:

I doubt anyone is capable of working 80 hours a week. If so many medical students can graduate from the medical school no problem, it means it is not 80 hours actual work... or whatever it is, it is manageable. People on forums like exaggerate things

It may not be 80 hours every week, but there are certainly many weeks where hours worked top 80-90, even as medical student. Furthermore, those hours don't even include when you are coming up to an exam as a clerk and your "not-at-work-hours" are spent studying. As a resident, the number of weeks where you clock 80-90 hours is increased and when you work 1 in 2 weekends, it doesn't take very long for those 80-90 hour weeks to go back to back. If you want to do any 5 year speciality you better be CAPABLE of doing extended work weeks.

As far as how to get to 80 hours per week.... easy... 2 call (26hrs x 2 = 52) + 2 post call days (0) + 2 x 12 hours days (=24) = 76 hours (plus miscellaneous crap incl. research, teaching, etc. that easily adds 4+ hours) or if you are working a weekend (which is every other weekend for residents and usually once per month for clerks) - 3x 26 hour call (3x26 = 78) + 3 post call days (0) + 1 x 12 hour day = 90 hours followed by right back to work for another 50-60 hour week on Monday (or more with more call). Again, plus any studying or work that needs to be done on your own time. I will also add to this that many small specialties aren't even guaranteed their post-call days or do 1:3 home call that often turns into a busy in-hospital call with no post-call day guaranteed.

I think there is some value in overnight call (whether its 24 hour or 16 hour) for clerks. Clerks are already shielded from a lot of the work residents and staff do, and its important for them to have a real experience before committing to a 5 year residency and lifetime of a specialty. I don't think it needs to be 1:4 as it is for residents, and even on call they don't deal with much of what residents deal with, but I do believe its important experience. There are lots of cases and other grunt work you do on call that you don't always get exposure to during the days thats an important component of any specialty.

Anywho... call is shit, and it's not just people on this forum exaggerating. The burnout, fatigue and work are real so I think saying its not 80 hours of actual work is BS and naive. 

[blah1234]

2 hours ago, robclem21 said:

It may not be 80 hours every week, but there are certainly many weeks where hours worked top 80-90, even as medical student. Furthermore, those hours don't even include when you are coming up to an exam as a clerk and your "not-at-work-hours" are spent studying. As a resident, the number of weeks where you clock 80-90 hours is increased and when you work 1 in 2 weekends, it doesn't take very long for those 80-90 hour weeks to go back to back. If you want to do any 5 year speciality you better be CAPABLE of doing extended work weeks.

As far as how to get to 80 hours per week.... easy... 2 call (26hrs x 2 = 52) + 2 post call days (0) + 2 x 12 hours days (=24) = 76 hours (plus miscellaneous crap incl. research, teaching, etc. that easily adds 4+ hours) or if you are working a weekend (which is every other weekend for residents and usually once per month for clerks) - 3x 26 hour call (3x26 = 78) + 3 post call days (0) + 1 x 12 hour day = 90 hours followed by right back to work for another 50-60 hour week on Monday (or more with more call). Again, plus any studying or work that needs to be done on your own time. I will also add to this that many small specialties aren't even guaranteed their post-call days or do 1:3 home call that often turns into a busy in-hospital call with no post-call day guaranteed.

I think there is some value in overnight call (whether its 24 hour or 16 hour) for clerks. Clerks are already shielded from a lot of the work residents and staff do, and its important for them to have a real experience before committing to a 5 year residency and lifetime of a specialty. I don't think it needs to be 1:4 as it is for residents, and even on call they don't deal with much of what residents deal with, but I do believe its important experience. There are lots of cases and other grunt work you do on call that you don't always get exposure to during the days thats an important component of any specialty.

Anywho... call is shit, and it's not just people on this forum exaggerating. The burnout, fatigue and work are real so I think saying its not 80 hours of actual work is BS and naive. 

100% agree. I had many weeks as a clerk and resident where it was actually 80+ hours of pure work. Literally running around trying to put out fires. It's not the norm (at least not in my specialty) but you need to be prepared because it does happen.

[ellorie]

Not to be rude, but I laughed at the "nobody can work 80 hours per week" comment.

I didn't do it much in psychiatry but it's so so standard issue in so many of the other specialties.  Just one Saturday call can easily push you to almost 70 without even trying even in psych (and I generally feel like I got off pretty easy from a residency perspective).

[offmychestplease]

I love it when premeds tell medical students/residents what medical school is like 

[neurologist19]

Sorry I didn't mean to come across as know it all and I don't want to discount your experience... take it as a personal opinion but I am a mature student (I have master's and work experience) and at this point my BS detector is quite sharp. Before starting grad school people told me grad student needs to to work in the lab all dat until 9-10 pm and it took me only going to grad school to find out how much far from truth those statement were. With medical school, It might be 80 hours of clocking in/out but I still doubt anyone could do 80 hours of work. Is it considered work if you idling at your desk in the hospital browsing social media? Do you consider the whole time you are ready to pick a call during your night shifts work? 

[TheFlyGuy]

24 minutes ago, neurologist19 said:

Before starting grad school people told me grad student needs to to work in the lab all dat until 9-10 pm and it took me only going to grad school to find out how much far from truth those statement were. With medical school, It might be 80 hours of clocking in/out but I still doubt anyone could do 80 hours of work. Is it considered work if you idling at your desk in the hospital browsing social media? Do you consider the whole time you are ready to pick a call during your night shifts work? 

I can't and won't even try to comment on the clerk/resident experience questions b/c I haven't lived it and only have some word-of-mouth from others (I do wonder how much of it maybe comes down to site-specific details?), but I imagine grad school might not be a bad comparison; in my phd program as a whole (and especially my lab for the first few years) the situation you describe WAS quite normal and the standard, was easily there 70 hrs a week on the regular and I was probably in the bottom half of our group when it came to work hours/productivity. It wasn't enforced as a rule or schedule, per-say, just expected within our group or you weren't seen as up to scratch. Whereas in other departments/labs, it really wasn't like that at all and was much more lax. I'm genuinely glad your experience wasn't in-line with what you heard, because some grad students really get put through the grinder and the effects on mental health can be pretty needlessly brutal (I count myself lucky in this regard, tough lab but really supportive advisor who was a real lifeline), but that doesn't make it untrue for others who may be living it. I'm with you on the fact that ppl can exaggerate stuff online sometimes, but I guess what I'm saying is that the grad school experience can be super variable depending on where you are and who you're with, and I wonder if clinical rotations, residency, etc are the same way in med (would love to hear ppl's thoughts on that/if it's true of I'm off-base). 

[bellejolie]

5 minutes ago, TheFlyGuy said:

I can't and won't even try to comment on the clerk/resident experience questions b/c I haven't lived it and only have some word-of-mouth from others (I do wonder how much of it maybe comes down to site-specific details?), but I imagine grad school might not be a bad comparison; in my phd program as a whole (and especially my lab for the first few years) the situation you describe WAS quite normal and the standard, was easily there 70 hrs a week on the regular and I was probably in the bottom half of our group when it came to work hours/productivity. It wasn't enforced as a rule or schedule, per-say, just expected within our group or you weren't seen as up to scratch. Whereas in other departments/labs, it really wasn't like that at all and was much more lax. I'm genuinely glad your experience wasn't in-line with what you heard, because some grad students really get put through the grinder and the effects on mental health can be pretty needlessly brutal (I count myself lucky in this regard, tough lab but really supportive advisor who was a real lifeline), but that doesn't make it untrue for others who may be living it. I'm with you on the fact that ppl can exaggerate stuff online sometimes, but I guess what I'm saying is that the grad school experience can be super variable depending on where you are and who you're with, and I wonder if clinical rotations, residency, etc are the same way in med (would love to hear ppl's thoughts on that/if it's true of I'm off-base). 

 

28 minutes ago, neurologist19 said:

Sorry I didn't mean to come across as know it all and I don't want to discount your experience... take it as a personal opinion but I am a mature student (I have master's and work experience) and at this point my BS detector is quite sharp. Before starting grad school people told me grad student needs to to work in the lab all dat until 9-10 pm and it took me only going to grad school to find out how much far from truth those statement were. With medical school, It might be 80 hours of clocking in/out but I still doubt anyone could do 80 hours of work. Is it considered work if you idling at your desk in the hospital browsing social media? Do you consider the whole time you are ready to pick a call during your night shifts work? 

So as someone who has done both a graduate degree and now medical school the hours worked in med school were much tougher. It obviously depends on the nature of your lab work but I find as a graduate student the hours were more flexible and I could work as much or as little as I needed to as long as the work got done. You’re also paid and compensated. As a clerk I’m working minimum 50 hours a week (and yes sure some of those hours I’m not 100% focused) and it is rotation dependent, but it’s very active work generally - you’re seeing patients, running around to get stuff, calling consultants, writing TONS of notes etc. Again Quebec is different because we have max 16 hour work days and no overnight call but we have IM evenings and all of mine I ended past 10pm (which is the legal limit) because we had two residents only, an r2 fam med, and R1 fam med covering the IM ward, geri and ICU (don’t freak out it was a community hospital), but there were falls, labs coming in, patients getting sick and you had to go and do assessments after a full days work already doing the above. 
 

i was a mature student going into medical school too, and honestly I felt the most burnout in ER because even if the hours are less you’re just always ON. And there are so many patients to see. Medicine for the most part is very active work, you get a consult you review the chart (which at night is tough - trying to comb through a patients entire hx when they have a million problems is tough), go see the patient, do the hx and physical, come up with a plan and then review with the staff or your senior. It’s just not the same as lab or any type of graduate work I’ve done personally. I’m definitely more tired. 
 

As well, I don’t care what anyone says but waking up at 4:30am to make it for gen Surg rounds is brutal and that rotation was super rough. Minimum 12 hour days 6-6 and you’re in the OR or following and doing scut for 50+ patients. 12x5 is already 60 hours. And our 72 hour work week again is protective compared to 80+ but still means you get one 12 hour call day and one day off. Was not nearly the same in grad school where I could write at home, read at home, take naps be in my pjs, and make my own schedule. Or in a lab where you’re not really “on” in the same way as you have to be in medicine. Not saying the work is less valuable it’s just different energy levels. Can’t listen to music while you work. 

[zxcccxz]

36 minutes ago, neurologist19 said:

Sorry I didn't mean to come across as know it all and I don't want to discount your experience... take it as a personal opinion but I am a mature student (I have master's and work experience) and at this point my BS detector is quite sharp. Before starting grad school people told me grad student needs to to work in the lab all dat until 9-10 pm and it took me only going to grad school to find out how much far from truth those statement were. With medical school, It might be 80 hours of clocking in/out but I still doubt anyone could do 80 hours of work. Is it considered work if you idling at your desk in the hospital browsing social media? Do you consider the whole time you are ready to pick a call during your night shifts work? 

I'm still a pre-clerk but I probably work ~80hrs/week with school taking up about 50-60hrs, and 2 research positions taking up another 20-30hrs/week. Many of the grad students in my lab are there ~80hrs/week as well. It certianly varies by program and lab group, but I think many of the students, especially at research intensive universities like UofT are willing to put in those hours, if for nothing else than to stay competitive with all the other students who are doing the same. It's so difficult to find an tenured position as it is, you really have to make every hour count. Back when I did my internship at Harvard, I would say that the expectation was that the interns worked at least 9-10 hrs/day, 6 days a week, and the the postdocs pretty much lived in the lab...

[neurologist19]

20 minutes ago, zxcccxz said:

I'm still a pre-clerk but I probably work ~80hrs/week with school taking up about 50-60hrs, and 2 research positions taking up another 20-30hrs/week. Many of the grad students in my lab are there ~80hrs/week as well. It certianly varies by program and lab group, but I think many of the students, especially at research intensive universities like UofT are willing to put in those hours, if for nothing else than to stay competitive with all the other students who are doing the same. It's so difficult to find an tenured position as it is, you really have to make every hour count. Back when I did my internship at Harvard, I would say that the expectation was that the interns worked at least 9-10 hrs/day, 6 days a week, and the the postdocs pretty much lived in the lab...

yeah I agree that the experience in grad school varies by a lot of factors. It is post COVID and I don't know how much people work. Pre-covid, and based on my experience in a few labs (solid experience at 2-3 labs) at UBC (Bioinformatics so no wet lab experiments), most people came in about 9 am and get out about 6-7 pm and 5 days a week. I cannot comment about their weekends or when they got home but no one was in the lab on weekends and after hours. Also, in all in all conscience, I cannot count the hours we spent in the lab as work, in a way that a person who works in a coffee shop and or a mechanic is working. We were our own boss, we talked, we thought about ideas, we attended talks, and days passed by so fast. So I literally might have worked 70 or 80 hours a week depending on how you would count but it was all fun and interesting things. I worked as a food delivery guy in my undergrad and working 20 hours a week exhausted  me to hell. That is why I am very wary of the numbers reported as working hours. Comparing numbers are usually comparing apples and oranges.

 

[hero147]

56 minutes ago, neurologist19 said:

Sorry I didn't mean to come across as know it all and I don't want to discount your experience... take it as a personal opinion but I am a mature student (I have master's and work experience) and at this point my BS detector is quite sharp. Before starting grad school people told me grad student needs to to work in the lab all dat until 9-10 pm and it took me only going to grad school to find out how much far from truth those statement were. With medical school, It might be 80 hours of clocking in/out but I still doubt anyone could do 80 hours of work. Is it considered work if you idling at your desk in the hospital browsing social media? Do you consider the whole time you are ready to pick a call during your night shifts work? 

There is some truth to your statement about having  some downtime especially during call for most specialties. But there are many specialties and rotations where you don't even have time to use the toilet. It's kind of hard browsing social media when you're being paged 10 times an hour while trying to get through urgent imaging studies as the only radiology resident in the hospital. And it's not like you can wipe out your phone in the middle of being scrubbed into surgery to browse the web. Also keep in mind, while you;re scrubbed into surgery, your pager is going off 2-3x an hour sometimes more that need to be answered in your "down time" between surgeries. 

[rmorelan]

1 hour ago, neurologist19 said:

Sorry I didn't mean to come across as know it all and I don't want to discount your experience... take it as a personal opinion but I am a mature student (I have master's and work experience) and at this point my BS detector is quite sharp. Before starting grad school people told me grad student needs to to work in the lab all dat until 9-10 pm and it took me only going to grad school to find out how much far from truth those statement were. With medical school, It might be 80 hours of clocking in/out but I still doubt anyone could do 80 hours of work. Is it considered work if you idling at your desk in the hospital browsing social media? Do you consider the whole time you are ready to pick a call during your night shifts work? 

You would be amazed on how hard people in many areas have to work and for how long - and I mean work with at best scattered breaks. Even as staff I work 60-70 hours a week routinely with sometimes more and just catch a brief random breaks to eat etc throughout the shifts. There are weeks that are not as intense, and I have way more vacation time than a resident would have, but even today medicine still has people truly going full steam ahead for what may on the face of it seem like very crazy hours. Residents have it way worse than staff still, and have to on top of the work hours find the time for a lot of studying as well. 

often for many these intense periods are not constant though for many fields (although if you are in surgery....) - there is a system in place that while challenging is not impossible to do. It just won't always be pleasant. 

That isn't super different than some other professional fields either I suppose - things can be quite intense. 

Edited February 22, 2021 by rmorelan