Residency and the 80 Hour Work Week

Performative overwork is more and more common in the United States, and long hours have long been the norm in medicine. During residency, doctors have traditionally been asked to work for up to 100 hours per week. A rule in 2003 capped residents hours at 80 hours per week. Older docs claim this practice skimps on training, and might be worse for patients. A new study indicates that there is no discernable reduction in quality of care across a number of metrics. Maybe the good old days weren't so great.

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[MaddyBlu]

The "I suffered, so you should too!" attitude is so detrimental to progress in society. Spending more hours training is not going to do any good if you are desperately sleep deprived while you are supposed to be learning. That should be common sense.

[Cthulhus_Mum]

My hours were capped at 66 when I was a bus driver - because of public safety. Why the f*&^ don’t we take doctors’ sleep as seriously as bus drivers???

[Twinnol]

Please make more episodes on topics like this. Resident burnout is a huge problem and organizations paying lip service to it by telling residents to exercise and eat healthy isn't solving that problem. Contrast resident shift lengths with US pilots who are capped at anywhere from 7-9 hours of flying time with shift lengths capped at 9-14 hours.

[MrCal]

Imagine a doctor at the end of a 36-hour shift treating you for a heart attack. I'm pretty sure it's not a good as a doctor who's has a good night's sleep.

[particularist]

Just wanted to point out that resident work hours are often under reported. This is because residents self report work hours. Repeated reports of 80hrs means the residency program may lose its accreditation. A resident is thus disincentivized to report longer work hours, for fear of graduating from an unaccredited program, which harms their career. While caps are nice on paper, what we need is culture change. Looking back during my own training (4 years of residency and 3 years of fellowship), I can confidently say that after 60-70 hours, it is diminishing returns for patient care and resident learning. I often reiterate to my older colleagues that medicine and patient care is far more complex compared to 'back in their day'. As such, the nature of medical training must also change.

[aderek]

Imagine your bus driver saying she is 35 hours into her shift on a 100+ hour work week.

[camcat]

If residents need to work 100 hrs/wk over four years to learn everything, maybe residency should be more years with fewer hours?

[roryokane]

Just as a comparison: working in the U.K. - we’re not allowed to work more than 48 hours a week on average (unless we opt out of the working time directive originally from the EU, in which case it’s 56 hours a week on average), with a maximum of 72 hours a week (measured as any 168 hour period); a maximum shift length of 13 hours and a minimum gap between shifts of 11 hours; a maximum of 4 night shifts or 5 long days (12h+) shifts in a row; and any night shifts (even one night) has to be followed by 46 hours of rest. I’ve no idea how people in the US do it.

[Eris-_]

This goes for nurses as well. If you have a twelve-hour shift for five days in a row, you're providing subpar and possibly damaging care starting on day three.

[brotendo]

Funny that doctors think that sleep deprivation is good for other doctors who are in charge of people's health and lives. Makes total sense.

[matemarijan]

It's one of the worst practices in medicine. After 8 hours or so I'm already so fatigued I start making mistakes. After 24 hours I would be probably be classified as heavily intoxicated

[fionafiona]

Same goes for pilots, I feel safer knowing they can be at their best and would gladly pay for their living expenses throughout longer education periods if it would reduce the hours.

[amschmarvelous]

In 2000 my mom was admitted due to stomach bleeding. She went into surgery and when she came out the resident, no doubt utterly exhausted told us they had not been able to reconnect her stomach to her esophagus and that she would have to have a stomach tube. That was not true. Apparently it was a discussed option during the surgery but they in fact did reconnect her. I honestly think that resident was just at nearly zombie level of tiredness. And he was in the surgery! It's terrifying to think that exhausted humans are doing such critical work.

[SpunckyJew]

I was in shock when you said they make $59, 000 - but not because it's high! It's WAY too low!! If you work nearly double what the rest of the work force works, you should be making at least $100, 000 should you not?!

[jalcalde]

my wife was doing Oral and maxillofacial surgery residency... They had her working 4-5 straight days with no sleep and she had to drop out last year and they were telling her to lie about how many hours they were making her work....she was so messed up mentally and physically...and those poor patients she had to see as a zombie.

[jennismith]

Look, anybody can churn out an isolated 80+ hour work week...the problem is that these people are having to keep this grueling pace up week after week, month after month.

[KaichuChiku]

My wife is a second year resident. Most rotations respect the 80 hour cap, but not all. I can also anecdotally say that those 80+ weeks are bad for her mental health and, to a lesser extent, mine as well.

[monkeyaround]

As a newly minted peds intern facing 80(+) hour weeks, thank you for this!

[JediBearBob]

80 hour weeks do still seem absurd, as do 24-hour shifts.

[LaughingGenius]

It has always boggled my mind that people in charge of life or death situations are expected to function on STUPID long shifts. Hire more people and work them fewer hours. It's not hard. It's just not. So glad that change is start to gain a *little* momentum.