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Hours per week

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I've heard some horror stories about the 120 hour work week, but those have all come from the States. My question is how many hours per week do 3-4th year med students and residents end up working in Canadian hospitals?

Also, they're apparently starting to enforce the 80 hour rule for residents in the US as well. Is there anything like that up here?

Needless to say, 120 hours seems like just a bit much

Thanks for any info

Cheers

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Although officially you are not allowed to work more than 80 hours per week in the US now, many programs routinely break that rule. Just this year, one of the Johns Hopkins residency programs (neurosurg? Can't remember) got their accreditation revoked for breaking it. I know of several other residency programs that still break this rule, among them the University of Washington.

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I worked close to 100 hours a few weeks while on medicine. Those were weeks where my call schedule was heavier: 28 hr weekend calls sure adds to your total for the week! Example:

Core 8am to 6:30pm work: 10.5*5 = +52.5 hrs

Add 6:30pm to 8am for a Monday call = + 13.5 hrs

Subtract 5.5 hrs off for getting Tuesday afternoon off = -5.5

Add 8 hrs for Wednesday call = + 8 hrs

Saturday 8 am to Sunday 12 pm call = 28 hrs

Total = 52.5 + 8 + 8 +28

= 96.5 hrs

Now Monday, Wednesday, Sarturday is call is unusual. Usually med clerks had call one in 6. So more realistic was about 70-80 hrs per week, depending if your call was on the weekend or the week.

And of course none of this included transit time to and from work or the like.

Now Surgery is much more insane. My roommate just finished his general surgery rotation. . . to make it blunt, I almost never saw him. His schedule was more like:

Monday through Friday 6am to 7pm (avg): 13 x 5 = 65 hrs

Tuesday call 7pm until 6 am: + 11 hrs

NO afternoon off Wednesday - he works 37 hrs straight!: - 0 hrs

'Saturday' call 6am Sat until 6:30pm Sunday, and his clinician sends him home 'early' (he's not to tell anyone about that treat!) because he'd been on call the night before: + 36.5 hrs

Total = 65 hrs + 11 hrs + 36.5 hrs

= 112.5 hours

Only 112.5 hours. See, no 120 hour work weeks here! We must be a bunch of slackers at UWO.

This schedule is actually NOT unusual for general surgery clerks. Call is 1 in 4. Obs/gyn is a bit better, but closer to surgery than medicine.

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Hopkins Internal Medicine got dinged for this after the ACGME guys got a letter from an off-service disgruntled intern. You should be expecting to pull up to, or over 80 hours a week on Surgery, and probably approaching that time frame on Internal Medicine, Pediatrics, and Obstetrics/Gynecology. Other rotations like Psychiatry, Emerg, Anesthesia will be lighter.

Third year is exhausting, but it's by far the best year of medical school as far as how much you progress in clinical knowledge and skill.

Ian

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It would be nice if gen surg call was 1 in 4....but alas, it is 1 in 3...that's why you never saw your housemate!!!

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It doesn't get much better as a resident either.

Sure, most provincial residency organizations (ie: PAIRO in Ontario) have contractural limitations on how much call you can do in a given period, but enforcement of these rules is inconsistent at best. I've done 48 hours of consecutive call in a row a few times, and was once startled to find myself on a call schedule for three days straight. :x

I remember trying to explain the scheduling dynamics of a particular two-week period of 1-in-2 call I had to some friends from high school. Graphically illustrated the importance of having friends who aren't in the same career position. Your colleagues often end up giving you a shrug with the "yeah, that sucks, been there" line... whereas "outside" friends are the ones who will give you the appropriate reality check by grabbing you by the head and screaming profanity-laden interrogatives at you about your lack of sanity until you're hearing impaired. :eek

- Rupinder

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They also accuse you of negligence for allowing yourself to work on patients having been scheduled for 30 hrs+ straight.

First time I shared my hours with a friend, they were disgusted and didn't react too well. Surprisingly, the only one who didn't overact was the one who is a reporter for the CBC. . . you'd think that he would be the guy to NOT talk about this with, but it turns out he works close to the same hours!

(obviously, he's spending his time chasing down surgery residents to interview about his big story about how medical residents are abused)

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It is absolutely insane the amount of hours that interns have to put in. I understand that there is a huge amount of information to learn and it has to be crammed into a 2-7 years program-but still, is it really necessary. Are you really there that much to take it all in or is there a bit of exploitation on the hospitals part to use residents as cheap labor?

As some of you know, I work as an Air Traffic Controller in Vancouver. We are not allowed to work more than 2 hours without a break, more than 12 hours in a day, and not more than 48 hours in a week. These hours are regulated by either Transport Canada or the Canada Labor Code.The reason for these times are obviously for the safety of the public, not to make sure we don't burn out.

I think there should be some sort of control on residents schedule also. I understand that the hours I work are not realistic for a resident but getting close to 115 hours per week makes me shake my head.

just my \$0.02

Cheers

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But if residents had regulations for work hours like that, the rate of medical error (which is relatively high) might approach that of the air trafiic controllers (which is very, very low.)

Who would want that?

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The obs resident I'm working with tonight (I'm on call) has told me they are NOT ALLOWED to work past 8 am post-call. For insurance reasons, given that it is such a demanding and fast-acting specialty, they are liable if something happens.

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The average physician IQ is 130 or greater, the air traffic controller is about 110 on average or less.

The problem is that there are not enough smart people to handle the job of physicians/surgeons. So if you reduce work hours, perhaps errors will decrease, but invariably more people will die due to physician shortages.

The MCAT is one big intelligence test designed to put smart people into medical school.

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Just wondering where that data is from cracked?

Are you saying that a high IQ makes a better doctor?

Seonagh

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It's a British medical journal publication, 1988, often quoted in the medical education literature.

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Aside from the BS that you have to have a 97th percentile IQ to be a doctor, the shortage of physicians is in no way related to the 'limited supply' of people smart enough to fill the role. Each year, every school in Canada has enough qualified students to fill the seats. In fact, in some schools like Queen's, you are shown to be as smart as anyone else in the class simply by be invited for an interview. That means that in Queen's, there are over 400 academically qualified applicants for 100 spots. If we let in every student that was academically qualified, we could essentially double the output of physicians from schools (and reduce the amount that each physician has to work). Why don't we? COST. The provincial governments can't afford to pay \$60k/yr to train each new physician. That's why it's so competitive. That's all. End of story.

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Yeah, we've had a few chats on this subject at UWO as well. One of the admin types (and in particular, the one who hates the fact he's an admin type and isn't afraid to offer his honest, frank and non-sugar-coated opinions to us) recently pointed out the same thing Stridor did: To be a great doctor, you don't need an IQ of 130. You need to be able to learn a system and then apply it meticulously so as to make as few errors as possible, work damn hard, and have a personality that will not piss (too many) patients off. The reason the average IQ is 130 is not so much out of necessity, but rather a matter of selection: they can't figure out a better way to sort out appliants, so they use IQ related measuring sticks (ie the MCAT, which I'd agree is an aptitude test, and less so, grades.)

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To follow up on Ian Wong's comment: "Hopkins Internal Medicine got dinged for this after the ACGME guys got a letter from an off-service disgruntled intern". After a thorough review by the ACGME and substantial changes in the policies at Johns Hopkins, the Internal Medicine program, I assure you, is quite intact. They have been granted provisional licensure with the ACGME and they will be monitored to see if they comply with these new guidelines. No other problems are expected with this residency programme.