Average number of hours/week for residency?

[Alastriss]

I was wondering what the average number of hours for residency was per week and which specialties had more/less hours

thanks!

[ffp]

Woah... this is really gonna vary depending on what specialty you're in, what rotation you're doing, and a number of other variables like how many other residents are on service.

 

For most things, your basic day is 8-5 Mon-Fri. Some surgical specialties start earlier/end later. On some outpatient rotations, your hours will be more like 9-4. Some rotations, like ER, you might work an 8 or 12-hour shift.... but to simplify matters, say 8-5.

 

Then, you have call. Call will vary depending again on your specialty and rotation. You will never do more than 1 in 3 call. I think that in most places, 1 in 3 is reserved for either home call, or acute-care call where you go home at 8am the next day. More typically, maximum call will be 1 in 4, or call one night in every 4. Some rotations will have less frequent call, and some rotations have no call whatsoever. As mentioned, some rotations allow you to take call from home. Typically, you go home at noon post-call (or at 8am post-call from acute care call).

 

So, to take the average week for a junior resident on a CTU rotation doing 1 in 4 call:

 

Mon - 8-5, call 5pm-8am = 24h

Tues - Work 8am-12noon, go home post-call - 4h

Wed 8-5 - 9h

Thur 8-5 - 9h

Fri 8-5, call 5pm-8am - 24h

Sat - off

Sun - Call 8am-8am - 24h

 

This is a total of 94hours in 1 week.

 

Please note that not every week will be like that - the Friday/Sunday combo is brutal and you don't do it every week.

 

Also, there are no defined "hours" in residency... essentially you stay until the work is done. If you get everything done early, sometimes you can sign out to the on-call person and take off as early as 3 or 3:30pm. sometimes on an outpatient rotation you might finish early and get a whole half-day off. Conversely, if things are busy, you are short-staffed, or one of your patients is really sick, you might stick around until 8 or 9pm despite not being on call... it's variable.

[Kirsteen]

Hi there,

 

In terms of call, one residency type that varies considerably from the standard 1 in 4 is Radiology. Once the PGY-1 year is over (where most programs have 1 in 4 call due to the requirement of Internal Medicine, Gen Surg, etc., rotations) the call decreases quite a bit. I interviewed at one program which boasted a 1 in 11 call and heard of another in Ontario where the call is 1 in 16. Most Radiology programs seemed to tout a 1 in 8 or 9 call.

 

Cheers,

Kirsteen

[blinknoodle]

Mon - 8-5, call 5pm-8am = 24h

Tues - Work 8am-12noon, go home post-call - 4h

Wed 8-5 - 9h

Thur 8-5 - 9h

Fri 8-5, call 5pm-8am - 24h

Sat - off

Sun - Call 8am-8am - 24h

 

Haha, this is almost like my week this week! What sucks is that everyone else enjoys a long weekend, and I am doing Friday & SUnday call and don't make up the loss of stat holidays.

 

Mon - 8-8 (it was a late day) - 12h

Tues - 8-5, call 5pm-8am = 24h

Wed - Work 8am-12noon, go home post-call - 4h

Thur 8-5 - 9h

Fri 8-5, call 5pm-8am - 24h

Sat - 8am-noon - 4h

Sun - Call 8am-8am - 24h

Monday - 8am-noon - 4h

 

I think I will be depressed if I total up the hours.

This is 1:3 call as clerks on CTU (not all rotations are this bad). We stay til noon post-call. Residents have 1:4 call, though.

[Smurfette]

I'd imagine (people who know better should correct me if I'm wrong) that it's not just the hours in themselves that's stressful, but the inconsistent late night cycles. I totalled up blinknoodle's hours (sorry!) to 105. If the hours had been 15 hours everyday (7am to 10pm) instead of the inconsistent 12-24-4-9-24-4-24-4 hour days, then there would probably be a little bit less stress.

[miss_sunshine]

Smurfette, I totally agree with you (although I haven't reached the clerkship or residency stage yet). I read an article that criticized the new 80 hour max work week saying that resident fatigue and fatigue related errors weren't due primarily to long work hours but rather the inconsistent work hour pattern as well as shift work schedules (the latter being mainly ER rotations).

[JewelLeigh]

I'm not in residency, but from what I saw during the surgical rotation of my clerkship, surgery residents work some pretty crazy hours, especially the juniors. An average week included 1 in 4 call (with a rotation like General Surgery or Ortho, call = lucky if you get an hour or two of sleep...others like ENT/Urology weren't as bad) and 6/6:30 am-5pm (often longer) days through the week.

[ffp]

Regarding the inconsistent hours... yeah... it takes a toll.

 

Right now in our cardio fellowship program, there is some controversy as to whether we should stack our call (we do 7 call/mo, but currently 3 of those are taken as a Fri,Sat,Sun back-to-back). Some people would rather just do a standard 1 in 4 rota. Our opinions are quite equally divided.

 

For myself, I prefer the stacked call. You feel like you're gonna die during that weekend on, and it takes a few days to recover, but then you have only 4 call the rest of the month, and 3/4 weekends off to have a life, study, moonlight, etc.

 

With straight 1 in 4, I feel just chronically tired. 1 night on, one day post-call that is totally screwed up (and since we are technically "home call", you don't go home early), post-post-call day (which for me is worse than post-call because the adrenaline-induced mania has worn off and you don't get the sympathy for being post-call), then one day where you feel kinda normal, but also feel compelled to go to bed early to prepare for your next call. The next day the cycle repeats. I feel like nothing gets done, and I never quite recover between calls. Also makes moonlighting tough.

[crackers]

This was my call this week... bear in mind, on Sunday at 10 pm last weekend I was in Cuba waiting to fly back to Canada.

 

Mon 8:30 to 7 - 10.5

Tues 7 am to 7 am - 24 hours (long day, early rounds)

Wed 7 am to 12:30 pm - 5.5 (then post-call)

Thursday 8 to 2 - 6 (academic half-day thereafter)

Friday 8 am to 8 am - 24 hours (but a light call, got some sleep)

Sat 8 am to 9:30 am - 1.5

Sun 9 am to 8:30 am - 23.5

 

so in 168 hours, I was on call or working for 95 hours, plus I worked 3 more hours this morning before going home.

 

However, I have no call now for 18 days (busy week, then 2 weeks off as a PGY-2 on GI).

 

My record is 103.5 hours, and my wife (surgical specialty) has a record of 112!

[miss_sunshine]

I've heard mixed things about surgical subspecialties. Ortho is rumored to be the hardest with the most demanding both on call and during the normal working day. How are the others like urology, ENT, optho, etc...? I've heard both ENT and Optho aren't that demanding after the first year with call being not that bad, although nowhere near as relaxed as rads. Is this true?

crackers, what residency are you in?

[Kirsteen]

I've heard mixed things about surgical subspecialties. Ortho is rumored to be the hardest with the most demanding both on call and during the normal working day. How are the others like urology, ENT, optho, etc...? I've heard both ENT and Optho aren't that demanding after the first year with call being not that bad, although nowhere near as relaxed as rads. Is this true?

crackers, what residency are you in?

Hey there,

 

I've heard that one of the worst surgical specialty residencies in terms of demand is Neurosurg. Long operations and lots of call. This will vary by centre, however.

 

Cheers,

Kirsteen

[quickdraw_mcgraw]

Up for 7 am rounds, 8-6pm OR, evening rounds home around 7:30pm.

 

On call 24-36 hours straight about twice per week.

 

Round on your patients every weekend, hour or two.

 

Thoracic surgery, keep your pager always on because you are on call 1:1 the whole rotation. This information isn't published.

 

This similar for most acute care surgical specialties; ortho, vascular, neuro, general, thoracics i can't think of any others, but I have been on call this whole long weekend and only had a couple of hours of sleep per night.

[Kirsteen]

Up for 7 am rounds, 8-6pm OR, evening rounds home around 7:30pm.

 

On call 24-36 hours straight about twice per week.

 

Round on your patients every weekend, hour or two.

 

Thoracic surgery, keep your pager always on because you are on call 1:1 the whole rotation. This information isn't published.

 

This similar for most acute care surgical specialties; ortho, vascular, neuro, general, thoracics i can't think of any others, but I have been on call this whole long weekend and only had a couple of hours of sleep per night.

Hey,

 

On one Gen Surg service I rose and shone at 4am each morning to be on the wards by 4:45am; rounds started at 6am and all the patient info had to be collected prior. Often, we wouldn't get off service until 8-9pm. I'd go home, eat dinner, read a little bit then go to bed and get up at 4am again.

 

Another Gen Surg service I was 1 in 2 or 3 call the whole rotation. We were expected to be there by 5:45am each morning. Post-call, going home at 12pm was not the norm. Most post-call shifts I was there until 6pm the next day. I recall one fond time when I was post-call and the junior, senior and I were in the OR for a liver transplant. I was the only one post-call and I was half-asleep during the entire procedure as I was observing most times, at best. At 4pm staff noted to the senior that he could let someone go--the senior let the junior go home. He didn't let me go until 6:30pm that night. Didn't really seem equitable, and he didn't have a chip on his shoulder re: me, but that was what he had to do and that was what you had to do to impress the big boys.

 

Kirsteen

[miss_sunshine]

not all rotations are like this? is it mainly gen surg and int medicine that are this demanding or do all rotations start this early/end this late/on call all the time.

[crackers]

I'm 2nd year internal medicine at UWO.

 

and rotations really make a difference.

Rheumatology for May and June is a very sweet two months of 9-4 and lots of sunshine.

CTU in January and February means you never see the sun when you're not pathetically tired...

[ffp]

Kirsteen - I experienced something similar as a clerk on the surgical rotation. We deduced that it was because the PARA rules applied to the residents but not to us... hence, no early post-call for us, no compensatory day off for working a stat, etc.

 

Speaking of this, I know for a fact that the horrendous hours in cardio fellowship are somewhat "voluntary"... and I think this applies to most surgical specialties as well.

 

In each province, your residency contract will stipulate maximum number of consecutive hours, going home post-call, etc. For example, when I do home call, maximum is 1:3, and if you are busy during the night (variably defined), I should be entitled to go home early the next day. Now... I'm sure that if I asked most of my attendings if I could go home, they would say "yes".

 

The fact is, though, I stay, sometimes until 7 or 8pm even if I've been on call for 3 nights straight. Certain rotations (like the cath lab) are procedure-based. On average, 8 caths are done in one lab during the day. If I left at noon post-call (7 call/month, and assuming that 5 post-calls are weekdays), I would be missing out on 4 angiograms X 5 days = 20 procedures over the course of a month.

 

This is quite significant, considering this is the only time I get to practice this procedure, and whether or not I am certified to do some of these procedures independently depends on the number I do during my fellowship.

 

Now... If I don't go home early when I'm on a "fun" rotation like cath, then leave early each time when I'm on a "scut" rotation, it doesn't look very good to my supervisors (although some fellows routinely do this).

 

I suspect some of the above applies to surgery as well.

 

Also, there's the sense of being "tough"... the sense in some of these specialties that if you go home early, you will be perceived as lazy, weak, and not wanting to learn (both by your attendings, and the other residents). Sadly, this is true to a certain extent.

 

That said, it isn't very smart to continue seeing patients and doing procedures when you are exhausted and physically can't take it anymore. That's dangerous for the patient, and medicolegally for you as well. I think that part of being "tough" is knowing how to identify your own limits, and if you really can't take it anymore, standing up to your attendings and saying so.

[ffp]

Yes, miss_sunshine, it is very rotation dependent.

 

Within an IM residency, there is huge variability (as crackers alluded to). Our ICU and CCU call is the worst (1 in 3 with long daytime hours), but you go home at 8am post call. CTU call is brutal, but when on subspecialties, we do only 2-5 call/month (depending on the number of residents in the rota), and this is just non-take call (babysitting the patients on the medicine ward). Most nights, you only get paged for things like Tylenol that you can handle over the phone. On some of these subspecialty rotations, you might have only half-day clinics, or work 9-4.

 

Neuro is home call and usually quiet after midnight. Nephro is home call... think I was called in a total of 5 times on my 2 months of nephro (although stayed until 9pm some days).

 

Some rotations are just SWEET. We do an "office" rotation where you go to the office of a downtown internist. Since we are supposed to be getting a sense of "outpatient medicine", there is NO CALL on this rotation

 

On our ER month, we do shifts... no formal call, but you might work an overnight shift. I loved it because I could sleep in every day and actually run some errands during working hours Also, since ER was defined by shifts, you simply handed over to the incoming ER doc or resident when your shift was over... it wasn't like CTU where you often end up staying late to tie up loose ends with your patients.

[quickdraw_mcgraw]

They don't tell you this when you apply for med school.

 

Ah well, I get to cut people open, that's pretty cool. I just hope it's cool at 3am when I am 55.

[Ollie]

Ah well, I get to cut people open, that's pretty cool. I just hope it's cool at 3am when I am 55.

I hear ya! My staff on OB was 66 years old and still doing regular 24-hour in-house call on L&D. I really, really can't see myself still loving my job at that point.

[BIH20]

Man, those are some crazy hours.

 

24hour shifts?

 

I'm not a med student, still in Uni, but this is one thing I would be very concerned about. After a night of sleep, I can do, 12 to 16hrs. I have worked jobs where I worked 12hrs straight but that's when I got at least 5 hours of sleep.(didn't find it a problem) But the issue is no sleep and continuesly doing that..I actually don't know if I could take that.

 

What type of stuff do you do to stay up? to help concentrate?

[quickdraw_mcgraw]

I do call for whole weekends.

 

That's surgery though. It's the price you pay for getting to do things as cool as surgeons do. It's worth it for me, I love putting people back together. Instant gratification.

[BIH20]

I can understand that for sure.

 

How does on-call work exactly? So you stay at the hospital? Do you have a chance to get some sleep? How does it usually go for you?

[Kirsteen]

How does on-call work exactly? So you stay at the hospital? Do you have a chance to get some sleep? How does it usually go for you?

Hi there,

 

It depends on the service and the centre. Some services/centres allow home call where you can stay at home (or somewhere outside of the hospital that is within, say, 30 minutes from the hospital) but many services require in-hospital call. That means that during the call shift you are within the hospital, or at least, very near by.

 

The amount of sleep you get depends on how busy the night is. During the night, if you're on a Gen Surg service, pe se, then you'll be in charge of any ER consults for Gen Surg as well as Gen Surg patient problems on the ward, e.g., increased heart rates, codes, Ativan orders, etc. I'm currently on Gen Surg and it varies from no sleep at all to 7 hours. The latter can be encouraged by good management skills, that is, rounding up the nurses on the Gen Surg floor at midnight and asking if there are any issues that need to be tackled, or going to the ER to scout out the possible consults for that night and tackling them earlier rather than later.

 

Cheers,

Kirsteen

[BIH20]

Thanks for the Kirsteen.

 

I know in a way it sounds dumb but I know myself. At about 20 hours of being up I am basically like a drunk. I can't concentrate that well at all and I just want to get some sleep so I can't imagine remembering things well at that stage.

I guess we are all different with a lack of sleep.

[Julie]

I know in a way it sounds dumb but I know myself. At about 20 hours of being up I am basically like a drunk. I can't concentrate that well at all and I just want to get some sleep so I can't imagine remembering things well at that stage.

I guess we are all different with a lack of sleep.

 

True, but I think many of us in pre-clerkship think just like you... We wonder how we'll manage... Somehow, people get through it!

 

I'm guessing coffee has much to do with it... that, Palm-like devices & quadriple-checking every important thing you do!