It was 8:50 p.m. and I hovered in the doorway of the resident workroom, trying to decide after a nearly 14-hour day whether I should go home.
My supervising resident and I had just handed over care of a complicated ICU patient to the night team, and even though we were both technically off the clock, she was still looking over the patient’s X-rays with the night group. I wondered if I should stay. I didn’t.
There are plenty of doctors who think I was wrong.
The debate over how long residents should work has been raging for years. Right now, as a first-year resident, I’m only supposed to work up to 16 hours at a time, then go home. More senior residents are supposed to work up to 28 hours in a row. We’re all meant to work up to 80 hours in a week.
But there’s a push to make me work that 28-hour shift, and longer, if I feel the care of a patient warrants it.
These long shifts take their toll.
After just two weeks on these ICU hours, already I felt unbalanced. My life outside the hospital was put on hold. The more time I spent caring for my patients, the less I cared for myself. I didn’t have time to cook healthy meals, exercise, or even spend quality time with my family. I’m a psychiatry resident, and we are encouraged to learn about psychotherapy through weekly sessions. That went out the window, too.
I will only spend four months of my intern year living like this, but I worry about my co-residents for whom this is a more permanent lifestyle.
By 2025, the US physician workforce will be up to 94,000 doctors shy of what what it needs to meet the health care requirements of the aging baby boomer population, according to the American Association of Medical Colleges. Burnout, which is what I expect these brutally long workdays will bring, can only make this problem worse.
The medical profession often talks about the need to have a work-life balance, yet the system sets too many of us up to fail.
If we do seek that balance, and make the choice to leave at the end of a shift to take care of ourselves, the implication is often that we’re selfish. The act of walking out the door when your day is done can call into question your professionalism, empathy, and commitment.
This is hard when — after sleep, commute, and work hours — you are left with one hour a day to eat, shower, and prepare to work.
Dr. Sandeep Jauhar recently wrote about an experience in which his intern clocked out in the middle of treating a patient with a stroke. “When you mandate that doctors have to leave the hospital … you may be creating a situation where new doctors start to think that shift work is the norm, and when someone is really sick, they can be handed off to another doctor,” he wrote.
That’s one of the reasons why the American Council on Graduate Medical Education wants to extend my workday. Dr. Thomas Nasca, CEO of the group, has said the proposal would reinforce the message to young doctors that “safe care of their patients supersedes any duty to the clock or schedule.” What’s more, he wants residents to have the option to stay at work even longer, if they choose.
Nasca maintains that an 80-hour work week still offers time for “a balance of professional and personal pursuits.”
I’d like to see the rules changed to empower us to find that work-life balance.
“The ACGME says that it is concerned about resident well-being, but it puts all the responsibility on residents to stay well under conditions that scientific evidence tells us contribute to stress, burnout, depression and even suicide,” Dr. Eve Kellner, national president of the union-affiliated Committee of Interns and Residents, said in a statement to the organization’s membership.
I made every effort to get to my therapy sessions, and I still wasn’t able to continue. I can’t imagine how someone working these hours constantly could get to help if they were in crisis.
So, what will happen? The 45-day comment period on the recommendation to extend first-year residents’ shifts is over. We’re waiting for a decision.
Meanwhile, I’ll be trying to balance my need to care for my patients with my need to care for myself. I can’t do one without the other.
About the Author Reprints
Maybe take a lesson out of the older generation in coping skills? Residency doesn’t last forever. Medicine is not a nine to five job.
It used to be standard practice to have three 8 hour shifts for all hospital nurses.
Now 12 hour shifts are mandatory — thus putting the burden of working on younger members. No wonder they burnout & no longer can last in a career of 30-40 years…
All doctors think the same during their residency but tend to forget this when they become senior consultants.
Residents do not use their free time to rest… so it is better to spend it in patient care than on FB or similar internet browsing
Are you a doctor?
You’re right, we don’t. We use it for studying, working on research and publications, as well as preparing for tomorrow’s patients and cases – not to mention catching up on endless documentation we might not have had time to finish during the day. That’s the real problem – just because you’re off the clock doesn’t mean you get to actually stop working.
It’s all about balance of work/family/self wellbeing! Outcome research has shown risks of medical errors with extended work hours and physician fatigue. More research needs to be done in not just hours of work but repetitive EMR entry of notes for a large case load and eye to hand fatigue contributing to medical
omission and commission in errors and medical judgement decisions!
There is a reason why we work in practice teams. I trust my nocturnist completely as a competent member of that team. The days of the lone practitioner are dead. Explicitly limiting call hours without solving the underlying problems of care coordination is a fools errand. The author needs to learn to turf her patients and be okay with someone else making the decisions for a while, or she will burn out.
Whine, whine, whine.
News from Northern California:
— the BART system has a janitor who works 17 hour days, seven days a week, for weeks at a time. Because of overtime, he is the highest paid employee.
— when one of my employers started requiring engineers to fill in weekly timecards, a problem emerged. The timecard system wouldn’t allow the total number of hours worked in a week to be three digits.
Are you a physician? Do you know the physical and mental toll of rounding on patients and performing difficult clinical problem-solving for hours on end? It’s a different kind of draining than purely physical work.
“But there’s a push to make me work that 28-hour shift, and longer, if I feel the care of a patient warrants it.”
If you can’t trust the people your turfing your patients to you need to tell someone, if you just can’t give up control then you are being incetivized to learn.
I am a practicing physician who also agrees in limiting hours of call