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Are Medical Residents Worked Too Hard?

time.com — Some experts say medical residents are tasked to the point of exhaustion, putting patient safety at risk. Others say the training makes them better doctors, even when they're tired

Who dugg this? Made popular May 23, 2009

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  • Thrustmaster, on 05/23/2009, -2/+29They're no Superman.
  • SkittlesUSA, on 05/23/2009, -5/+31This is why I cannot bring myself to say health care is a right.

    Could anyone walk up to a man who has spent his entire 20s in medical school, taken hundreds of thousands of dollars of student loans, worked the trenches of internship and say "I have a right to your service for the amount the government is willing to pay you."

    Of course there are MANY problems in our health care system. But as this article points out, the medical field is very arduous and we need to be careful to not drive away future medical students during this fragile time.
  • inactive, on 05/23/2009, -3/+28Yes.
  • buckrogers1965, on 05/23/2009, -1/+21Any professional who has the lives of other people in their hands should not be allowed to work without 8 hours sleep in the past 24 hours. This is as true for truck drivers as it is for doctors.

    I certainly don't want someone sleep deprived performing any medical procedures on me or mine unless they are fully rested.
  • wamerocity, on 05/23/2009, -5/+25As a first year med school student, this question is very appropriate for me. The 2 main areas I'm looking into are OB/GYN or Gen. surgery, and both of the residents in these programs will work 120 hours/week despite regulations. Sure a resident can stand up for himself and demand that they go home because they've hit their 80 hour quota, but nobody does so because it's such a competitive system. Who wants to be seen as the guy/girl who only will do the minimum required? I've seen the new recommendations, and they aren't that different, but one of the major changes is that now they can't divy up the required rest time into pieces. They must be given a whole 24 hour shift off, not just 24 hours off over the course of a week. It's likely that all these new recommendations will be overlooked by residents who want to stay on as an attending though.

    There is so much to learn in residency, and it is a legitimate concern whether all the necessary information can be learned in "only" 80 hour work weeks.

    And to think, most residents make about $40-50k/year, which translates roughly into $7-$10/hour depending on how many hours per week they work. Crazy stuff.
  • Craftystar, on 05/23/2009, -1/+18As a medical specialist who trained and works in Australia, I really can't understand the American system. I initially started training to be a surgeon and I would regularly work around 80-100 hours a week at that time, I later switched to Radiology which was the best decision of my life. As doctors we know that working long hours is not only dangerous to patients health but also dangerous for our own. I know of at least 2 doctors that died in cafr crashes when driving home after 24hour shifts.

    In Australia they introduced fatigue pay, so that once someone works more than 16 hours without an 8 hor break, the hospital has to pay them double rates, this has reduced the unsafe hours dramitically, as money is the only thing the hospital administrators listen to.

    I don't buy the argument that you need to work more than 80 hours a week to learn to be a good doctor, how well are you really learning when you're fatigued? It certainly wouldn't give you much time to go away and read up on interesting cases you've seen through the day and work out how they could be managed better next time.

    Lumping doctors (or anyone in the health care system) with a $250k debt to a bank also seems insane to me. What the tax payer saves in univerisity fees they will more than pay for later down the road when they want to see a doctor, who has to increase his fees to pay off his loans. It would also favour children from more wealthy families doing medicine, as the debt would seem very daunting to many, so that doctors would end up coming from a narrower part of society.

    Working both in the private and public (for the Government) system in Australia. I can tell you which one I think works best. In the public system, you are always thinking about what is best for the patient and money doesn't come into it. In the private system, the patient is still important, but so is making money so considerations about what extra tests you can do also come in account. There is alot of overservicing in private medicine in Australia, which I know also happens in the US. This has to be one of the reasons the US has the most expensive health care systems in the world, yet rates fairly poorly in health outcomes. As a doctor it is far more rewarding working in the public system, whilst the money isn't as good, at least you know you are treating those people who really need help, rather than the "worried well" who can afford it.

    Sorry for the log rant, this is my first post on Digg.
  • Krekko, on 05/23/2009, -1/+17My dad, aunt, and uncle are all doctors. I have seen them all ( especially my dad) worked down to the bone. The field of medicine, especially practicing in a hospital is a rough road.

    My dad gets up 5-6 days a week at 4:30 to start his day, and head out to work. He does not leave the hospital until around 7:30pm, or many times as late as 11pm.

    It is a grueling field to be in. Amazing pay, but you do have to go through many years of school then training, then to work yourself down to the bone. This is like saying "Is Boot camp too tough" Maybe, BUT it does help better prepare them for the road ahead, one that will make the training look like a cake walk. If you want an easy going job, I suggest re-evaluating the field you are in. It just gives you a small glimpse at the world ahead of you. I have heard this issue discussed many times before, and each time the doctors have all say the same thing, If you are unable to handle your residency, good luck later down the road.

    If you want an easier field, consider becoming a Physicians assistant, the greater majority of doctors I have talked to recommend this. It is a lot easier, and a lot less intensive.
  • KarthVader, on 05/23/2009, -2/+18Sorry to flame you, but drunkenoaf, you must BE what your name suggests. You seem like one of those types that thinks doctors are "robbing" you blind.

    4 years of undergrad - $40K
    4 years of medical school - $100K+
    4+ of Residency, internships, fellowships, and post graduate work and then realizing that society still thinks doctors make too much money after they are done with medical school.... Priceless
  • Soniti, on 05/23/2009, -0/+15Let me just say- As a surgical assistant, I work with residents on a daily basis, and to say that they're worked too hard is an understatement. Numerous times, in the middle of surgery, the resident will need to "take a breather", and break scrub, and end up sitting in the corner on the verge of collapse. They're on call pretty much 24/7, and the staff surgeons have no pity for them. I don't understand how they can work so hard- long after I'm sitting at home, drunk and on digg, they're still at the hospital seeing patients, hours after their staff surgeon has gone home.

    It's a highly unfair, exploitative, and vindictive system, which only endangers patients so that the "real doctors" can feel like the residents have "earned their stripes". ***** that *****.
  • woodrail, on 05/23/2009, -0/+14But don't you learn less when you're tired? Your ability to focus on the material goes down. You definitely screw up more often when you're tired.
  • LordZeal, on 05/23/2009, -1/+15I have two friends who are both residents. The first is getting ready to start his 3rd year and the other is getting ready to do his 1st year again, not because he had a low performance, but because the Match Program screwed him over for a full 4 year slot. They both routinely work 100+ hour weeks and are REQUIRED to report 80 hours so the programs don't get in trouble. This is considered normal and so no one complains because everyone else had to do it. They work 30+ hour shifts as often as every 3 days and get 2 days off a month. Yes 2 days in the whole month, weekends are not days off. It's insane. And yet the medical programs need them to work these hours because they are under staffed, yet they can increase the number of residents they can have at the hospital because of other rules in the industry.

    They get two weeks vacation a year and a lot of times those weeks are SET, they don't get to pick them. I've had my friends miss weddings and tons of other events because they could not get off, even months in advance. For all of this residents make about 43k a year. Work out 80 hours a week at 43k for the year and tell me what their hourly wage is. They also had to amass over 250k in school loans. That's about a monthly payment of 3k when they do finish residency. So yeah, SOME doctors can make a ton of money, but if you work it out they don't end up getting ahead of some of the other medium income professions until way later in their lives, and a lot of times they still work 80 hour weeks. Let's not forget one screw up and you lose your license and then all that work is for nothing and most of the time the money you make is determined by what the insurance companies choose to pay you. I still can't believe they still can get students to choose to become doctors. I sure don't think they do it for the money anymore.
  • mrrover, on 05/23/2009, -6/+20Oh my God. 30+ hour shifts... My respect to med students suddenly grew.
  • lisaawesome, on 05/23/2009, -1/+15I worked a continuous 14 hour shift once at a job and that was brutal for me. I never understood how residents could do 30 hours. I get nutty after a while!
  • wamerocity, on 05/23/2009, -3/+165 years? Ha. Try more like 10-15. I'm going to graduate with $250k combined from undergrad and med school. If I take the shortest road and become a family physican (only 3 years residency) and take a salary at $150k, after taxes and malpractice insurance, I'll take home $80k. Guess how long it takes to pay that off? It's a large mortgage payment. Besides, doctor's pay has steadily been decreasing for years. If you are part of a managed health care system, like much of California, you'll be lucky to make $90k BEFORE taxes. At the rates the government reimburses people at, many clinics LOSE a little money with every patient visit, and many physicians are unable to keep a private practice in business because of it.
  • DirtPile, on 05/23/2009, -2/+15Not as handsome as you think. You've still got fellowships and the like. And if you're in research, like soon-to-be-me, nothing is handsome. And if you're in peds or family medicine, then not at all.

    Anyone who becomes a physician to get rich is delusional these days.
  • LordZeal, on 05/23/2009, -1/+13How about that the insurance companies dictate how much a doctor makes when he sees a patient. If it takes him a hour to work the up the patient or 20 minutes, insurance pays the same low rate.
  • robbh66, on 05/23/2009, -2/+13Don't hate on other people because they were willing to bust their ass to be successful.

    Besides, you have no idea what you're talking about. Their are MANY other career paths that people smart enough to be doctors can do that are much easier than the medical profession.
  • LordZeal, on 05/23/2009, -1/+11Much later, keep in mind they've already had 8 years of school, plus they have to do 4 to 5 years of residency and then they acctually start making some money, but oh yeah they have over $250,000 in school loans to pay off. That's a 3k a month payment there.
  • UnknownHero, on 05/23/2009, -0/+10As a third year medical student residency hour restrictions are pointless. Most hospitals ignore the current recommendations, so tightening them is futile. If they do have to obey, they can't hire more residents to cover the hours freely (resident salaries are paid for by the state and feds, and subject to a slow approval process). This will result in more medical students, PAs, and nurses who are unqualified to deliver total care covering the gap in hours.

    There was a proposal last year to limit residents to 40-60 hours a week. This was incredibly unpopular among residents, because it was accompanied by an increase of a 3 year residency to 5 years and a 5 year residency to 8 years. Fellowships would become 5 years instead of 3. So if you want to be a doctor, you (currently) spend 4 years in college, 4 years in med school, accumulate a quarter million dollars of debt, and then work brutal hours for 3-5 years for a wage that computes hourly to that less than that of a McDonald's manager. Some people come back for 3 years more for a fellowship to learn how to be a specialist. It's insane.

    However, I learned the most of all when I was 20+ hours deep in a 24 hour shift. You're not really impaired, just tired. And most doctors sleep for (small) portions of their 24+ hour shifts, in between pages in the middle of the night and whatnot. It's not that bad- except in certain hospitals that are packed, poorly run, and poorly funded (think county hospitals). Those places are brutal.
  • pjt3186, on 05/23/2009, -1/+10Just as a free tip to anyone here. If you get into a hospital and have attendings and residents performing however many procedures on you, it is your RIGHT to ask how many hours they have been on. I love it when a patient asks how long I have been working, and then requests someone who hasn't been on for the past 26 hours to my attending. I would never allow myself or a family member to be subjected to some of the sloppy procedural work and handling of cases I have witnessed due to overwork.
  • DirtPile, on 05/23/2009, -3/+12Your comment is so far from the truth, it makes me laugh. You forget the necessary fellowships a physician/surgeon must complete, and you forget medical school debt, at the very least.
  • dagamer34, on 05/23/2009, -0/+9Because other people don't take out $150k+ in loans to get there. If you're just focusing on take-home pay. You're an idiot.
  • dagamer34, on 05/23/2009, -0/+9Research scientists (aka PhDs) often get paid during their schooling or working in a lab. Med students take out loans to pay for tuition. It's VERY different.
  • DangerCollie, on 05/23/2009, -0/+9I'll bet the people saying it makes them better doctors are the people benefiting from these poor people working themselves to the brink of psychotic episode.

    At work we're talking about setting up sort of an exchange. Get 200 people to put up $1,500 each per year and then hire a doctor just to take care of them. Most docs would make more money, especially early in their career. Just seeing 10 patients a day, they could see everyone in less than a month.

    Then you could keep insurance just for hospitalization and you'd have your own doc to consult even at the hospital. Even if it was 200 families, that averages out to around 600 people. Most of the docs I know see between 20 and 30 people a day. Even seeing just 10 patients a day, they could give everyone a checkup every other month.

    The docs would make more money, work way less, have fewer headaches, no insurance forms to mess with, and patients would get a level of care you usually have to move to Europe to get. $3K for my wife and I...I'd do it. Especially if we could cut our insurance coverage to catastrophic and hospitalization. I bet we'd make up most of it in insurance premiums.
  • smemily, on 05/23/2009, -0/+8Same here, my longest shift was 17 hours, and exactly none of it was on my feet, nor was there any panic or pressure to save lives, and I still was exhausted at the end.
  • mweels, on 05/23/2009, -0/+8
    I know this a bit off topic, but I sometime wonder if we all work to hard.

    I was reading some information about a native indian tribe that use to live where i do today.

    They spent four hours working and the rest doing ceremonies and basically hanging out. These were hunters, gatherers and farmers.

    How is it that we are suppose to be an advanced society and it now takes most of the population both parents to work to support their life.

    Is our goal to be more productive as a society or enjoy life more? Bit off topic, but this article struck a cord.
  • billyvnilly, on 05/23/2009, -2/+10It's expensive because medical students are insured, at least that's why mine was expensive.

    And its necessary to work that hard because hopefully during your 80hr work week, its all educational to a point. If you were to cut it down to 60, you are missing out on 20hrs of education each week. multiply that by the 3-4 years of residency and you've missed out on a lot.
  • wamerocity, on 05/23/2009, -1/+9Well, that assumption could work, assuming money was your sole motive. But I think that most students who get into medical school want to make the system BETTER, not siphon money from it by taking advantage of poor tort statutes. Those kind of people typically go into LAW.
  • KarthVader, on 05/23/2009, -0/+8Nothing against research scientists, but I rarely see any of them pulling 80+ hours a week. Their staff might, but definitely not the PhDs.
  • DirtPile, on 05/23/2009, -3/+10I lol'ed at your ignorance.
  • RavagesOfTime, on 05/23/2009, -0/+7*insert Dr. Cox rant*
  • geekdoc, on 05/24/2009, -0/+7You definitely do not acquire anything after working a 100 hour week. Your brain doesnt process information well when you're sleep deprived. You end up tired, cranky and make the day about how cranky and tired you are rather than about the patient. You do end up losing or at least see an erosion of empathy.

    The highly rigerous system leads to a substantial amount of serious medical errors. This paper (http://content.nejm.org/cgi/content/abstract/351/1 ... indicates as much when it comes to medical interns (me!) but I'm sure we can extrapolate to medical residents who work longer hours than us lowly students.


    A few years before I got to medical school they passed a law stating residents could not be asked to work more than 80 hours / week. Not every hospital got that memo...
  • NiceToMEETyou, on 05/23/2009, -0/+7Ah the sagacious cawpin!! Oh cawpin please, spare a moment and descend from your high mountain, where you spend your days drinking sweet nectar and playing WOW, and tell us how to fix the medical establishment and residencies?
  • tmlee, on 05/24/2009, -0/+7Just to give you an idea of my week:

    Day 1: 5 AM to 9 PM in the hospital. Rounded on our patients until 7 AM. Had breakfast. Went to the operating room at 7:30. Worked on 4 patients. The 3rd took much longer than expected. Finally got out of the OR at 8:00. Made sure my patient was stable and left at 9
    Day 2: 5 AM to 8 PM. Rounded on patients. Conference presentation (sucked horribly) on 3-4 various articles. Clinic until 7 pm (last appointment was scheduled for 5:30 pm but we went over). Worked on notes until 8.
    Day 3: 5 am until Day 4 11:00 AM (about 30 hours). Rounded. Operating Room. Took over two other surgical services. A total of 30 patients to manage. 3 were in the Intensive Care Unit (ICU). Overnight admitted a few patients, 1 with appendicits, did an appendectomy. 1 hour nap around 3 AM. Woke up to several pages, finished a lot of discharge paperwork. Rounded at 6 AM. Worked on more notes and went home at 11 AM.
    Day 4: Went home at 11 AM, rested. Went crazy buying stuff on newegg to build a new computer...gym...swimming.
    Day 5: 5 AM until 9 PM. Rounds and OR.
    Day 6: Took another call night. 5 AM until 11 AM (Day 7). Pretty much the same as Day 3/4. Had a patient come out of anesthesia with significant difficulty. Sent him to the ICU.
    Day 7: went home at 11 AM. Took a short nap. Watched Terminator.....it was okay. Currently on Digg. Probably play some Halo 3. Will go into hospital tomorrow bright and early... :)

    I'm still a student paying $40k a year...but I really, really love what I'm doing.
  • wamerocity, on 05/23/2009, -4/+10It's expensive because you need expensive people to teach them, e.g. Doctors. It's also requires a lot of resources. Medical equipment is expensive. Hospitals are expensive. Books are expensive.

    And it's not's just a technical skill. Don't let Dr. House fool you, doctors need to have good analytical skills, technicals skills AND personal skills.
  • LordZeal, on 05/23/2009, -0/+6Because they need the bodies, yet laws set how many residents a hospital can bring on, and its way to few. Not to mention that the amount of training they need to go through while a resident is insane.
  • Gloogle, on 05/23/2009, -0/+6lol, thats what my uncle does at his private practice and his filthy rich because of it. Plus, it gives him more free time.
  • icndvl, on 05/23/2009, -1/+7You would have to be crazy to give up your youth like that. I don't care how much money you can make.
  • Dr.Lehoux, on 05/24/2009, -0/+6You work 30 hrs straight.... but that's not all there is to it.
    I carry 3-4 pagers that go off all night long. You have no designated break time, so you grab something to eat in a real hurry.
    Not only are you dead tired and sleep deprived...you also have to deal with people who are pissed off because of long waits in the ED.
    Drunks and low lives in the middle of the night....
    No wonder we have the highest suicide rate of any profession...
  • Gloogle, on 05/23/2009, -1/+7to retain memories you have to sleep it's SCIENCE.
  • DrDigg, on 05/24/2009, -0/+5During my internship we got 2 days off a month. The ICU rotation was the worst because you would have to work overnight every third night. You were so busy during the day that you would only have time to eat one meal (brunchner = breakfast-lunch-dinner). If you averaged out the pay it was just barely above minimum wage. After my intern year we got reported and put on probation. Things got better after that. We developed a night service which would cover most services at night. There was always concern about passing off care of patients, but I think the old system was more dangerous.

    BTW - I've lost track of how many weddings, birthdays, graduations, anniversaries, and holidays I have spent at the hospital. Thank god I have an understanding wife.
  • fleyinberdy, on 05/24/2009, -0/+5At Hopkins, we had a 150+ student protest against the new duty hour restrictions proposed by the IOM. I know it may sound absurd to someone on the outside, but the trainees stand to lose the most from these restrictions on duty hours.
  • docbob84, on 05/24/2009, -0/+5Also, 95% doesn't work 60-80 hours a week, or be at work at 7AM 7 days a week for rounds, or have the constant threat of lawsuits hanging over their head. They also don't pay 1/3 of their pay for the privilege of doing their job (gotta love malpractice insurance).

    There are a lot of undergrads out there who read Digg who are thinking about medicine. I love my job, but take my advice. Figure out how to shadow at least three physicians. And when I say "shadow", don't meet up with them at 8AM and leave at 4PM. Ask to stay at their side for 3 days minimum. Offer to pay for your own food and expenses, but see if you can find a doc in your hometown willing to let you camp on their couch. When they go on rounds, you go on rounds. When they stay late doing paperwork, you stay late. Really learn what the lifestyle is like. If you love it you'll do great. But it's not something you should jump into blindly.
  • Gloogle, on 05/23/2009, -0/+4doctors have the knowledge on how to save people's lives, that is what is special.
  • Gloogle, on 05/23/2009, -0/+4you wont be a able to store half of the information, you'll be asking questions on how to the same procedure half of the day
  • Quaestor44, on 05/24/2009, -0/+4I like you
  • FrankFutter, on 05/23/2009, -0/+4I read this as sarcasm, and I lol'd. I read the comments and I think everyone else missed the sarcasm, or else it really is stupid and there was no sarcasm. I like to believe it was all sarcasm in there.
  • jp83avalanche, on 05/23/2009, -0/+4I agree. I mean as a pharmacist I pull 12-14 hour shifts...standing most of the day, and interacting with people, some of which fell quite close to the "not so bright" tree. And I'm dead after those days. I can't imagine what they go through. Much respect.
  • medfreak, on 05/24/2009, -0/+4I am an internal medicine resident, and to some extent we have it better than the surgical residents (don't tell them I said that!) But frankly I enjoy my work, and I don't mind my long shifts as long as I have something to learn. It all depends on the work area and the team you are working with. It can be hell and it can be the best time of your life. My longest shift was a 34 hour shift in a hospice / Palliative care for cancer patients.
  • fleyinberdy, on 05/24/2009, -0/+3Why is this dugg down?
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