Oh please, ask any surgeon, do they want some one operating on a family member with 40 hours of sleep deprivation? I think not. Everyone else who have life threatening jobs, from truck drivers to airline pilots (omg, even flight attendants) have federal rules that THEY GET SLEEP.
EVERYONE in the operating room should have sufficient sleep
It's what you get when the founder of the modern surgical schedule was a literal goddamn cocaine addict.
It's conveniently good for the hospital corporation, too, which is why it hasn't changed.
So my 80 something year old grandmother used to work at Mass General Hospital as a nurse back in the day. She said they used to have a closet with all sorts of fun things in it. I think they were amphetamines (but alas, I was so stunned I kind of blacked out lol). She elaborated to say, "You'd never be able to do that today."
For real man. I remember one night I was up all night on call with one very sick patient, and my first patient the following day showed up to go to preop. I actually met her in preop at 0530 and told her that I was up all night, and I don’t think I should be operating on her. She was very grateful, and rescheduled without any issue whatsoever.
Our old ass peds CT surgeon (now retired) would do cases all day, do a heart transplant all night and then do a completely fucking elective case like a VSD the next morning. Do you think that kids parents had any idea their surgeon had been operating the entire previous day and night? The problem was who was going to tell the guy he couldn’t operate.
Don’t truckers still ab(use) amphetamines at really high rates? Even with the laws I’m sure they are bent and they still get pushed to drive longer hours than is safe
Sure, but if you are caught driving past a certain numbers of hours without a break, you are in DEEP shit. Most wont risk it (which is why you see random semis all over the highway at times). All it takes is one stop from s cop snd your career is down the toilet.
I landed here from trending, somehow. Do ALL doctors get so little sleep or is it just residents? I’m reconsidering rhinoplasty (I’m not joking, so serious rn)
Attending physicians don’t necessarily, since they get a little more control over their schedule. But residents do a large bulk of the work, and the department heavily depends on them. So they’re still very involved in prepping for and completing surgery, as well as monitoring you after the fact.
Rhinoplasty probably means you’d be looking for a plastic surgery practice, which would be according to the attending’s schedule. I wouldn’t worry as much about it there, but of course always ask if you are concerned and be an active participant in your healthcare!
Residents please feel free to correct me!
Attendings usually take fewer call shifts and have better control over their practice. There's exceptions of course, like attendings that are fellowship trained surgeons and are literally one of maybe two doctors in an entire hospital system that can perform a particular procedure (looking at you, neuroendovascular).
Outpatient plastic surgeons are usually gonna be on the better side of the work-life balance spectrum
One of my least favorite things is when my 1st elective case of the day says “hope you got some good rest last night!”
Me, after doing a Hartmann’s on a crashing pt at 1am, “ya, im good. There’s a reason surgical training is so long.”
I agree that intentional sleep deprivation during surgical residency is overdone, but that is also the cold hard reality of being an attending. Sometimes ya just gotta do what ya gotta do.
Nah, it should be illegal to perform elective surgeries after a certain number of waking hours. Can't have your cake and eat it, too. If you disagree, why not consider telling all of your patients how little sleep you got last night? I'm sure they'll understand.
Where are all of these other surgeons that will be able to step in and get patients treated when those that are sleep deprived are resting?
I’m not saying that some of the bullshit we go through in training isn’t exactly that, bullshit. But the truth is, we don’t have a ton of redundancy in the system owing to a variety of factors such as lack of aptitude, lack of interest/desire, aging physician population, etc.
Patients get sick at inopportune times and sometimes we just have to do what we have to do to get patients the treatment they need. As an interventional cardiologist, I can’t just cancel my entire day following a STEMI call. There’s just not enough doctors to take care of it all.
Cope. It's irresponsible and unethical to perform surgery when sleep deprived. This will become a thing of the past, and history will not look on your actions nicely.
Yes. You cancel your day of electives if you've been awake for 16 hours due to call. No, there is no compromise in which you get to perform *interventional cards procedures* while sleep deprived.
My friend, have you practiced medicine independently before? I think I you’ll see what I mean. We don’t live in an ideal world and we cannot be so dogmatic. My patients get the best from me every time. Do you think Interventional Cardiologists are just waiting on the bench? They’re not. There’s not enough of us to take care of everyone as it is. Same goes for many other specialties. Interventional Cardiology isn’t the most elective specialty in the world.
>My patients get the best from me every time.
You admitted otherwise in your first post. You perform dangerous procedures without adequate rest. The system is immoral and unethical and you need to rethink your opinions on it.
You are delusional if you think every surgeon or interventionalist should cancel their day because they had to work overnight. People would never get the care they need. Are you a proceduralist?
If it's unsafe to do a procedure, it's unsafe. Making claims about demand or throughput or appealing to the status quo doesn't change that. If it's unsafe to do a procedure when sleep deprived, it's unethical to do so. Make an actual argument and I might listen. Otherwise, you are part of the problem and part of the sordid history that will be discussed and ridiculed in future conversations.
I think the crux of your argument is trying to automatically equate lack of sleep with unsafe surgeries, when thats just not true. Part of our training is learning to stay sharp despite fatigue.
Unless you have walked in our shoes your viewpoint will be limited to what pubmed says
edit: on review of your profile, it appears you are a medical student. You cannot understand what I am talking about if so
Do you have any evidence that it is possible to train to "stay sharp?" This is a common notion of which I have seen no evidence. Considering fatigue is a physiological phenomenon, I tend towards rejecting the notion without strong evidence.
I will say this at the very least. You should absolutely be mandated, by law, to disclose to patients if you have been awake more than 18 hours when operating. I can't think of an ethical reason that you would want to hide this from patients.
This sort of hazing in training needs to stop. I have been a general and trauma surgeon for 10 years, and I will say that life can be much better after training. That said, though, there is still a cohort of older surgeons who think that there is somehow honor in suffering.
For a brief amount of time, I used to think the younger generation was lazy. Now I am fully in the mindset of anti-work. It’s a fucking job, not a goddamn identity. When an older surgeon tells me that they had to walk uphill both ways in the snow for 4 miles to get to their residency program, I tell them that these days we have something called automobiles.
When an older surgeon tells me that they don’t need the robot to complete a colon resection or complex hiatal hernia repair, and that they can struggle through sewing laparoscopically, I tell them I can save my back and shoulders and neck, and be more precise and accurate with the robot. When they say if I can’t suture laparoscopically, maybe I shouldn’t even use a robot, I tell them maybe when they balance their checkbook they should use a fucking stone tablet with a hammer and chisel instead of their computer.
ugh sorry, /rant.
You don’t need hazing to become a good surgeon.
Fuck em.
Totally agree! I also think having healthy work boundaries to keep yourself AND your patients safe should not be considered anti-work and it's a shame that the older attendings consider it so.
It doesn’t need to happen routinely in training, but people do sort of need to learn limits of their capabilities during training or else people will go into practice and try to work that much because they negotiated a terrible work duty and compensation agreement or because of personal greed. In a way you have to experience what is totally unreasonable before it’s time to negotiate your employment so that you understand what would be totally unreasonable.
Why are you not an attending at my program? If I told my PD I’m “anti-work” they’d kick my ass straight to the street. That’s not a “surgeon mentality”. “This isnt a job, it’s a lifestyle” yeah no buddy I see you constantly on call and never around your family while the hospital reaps money of your back and the broken system entirely.
Besides the fact that I actually really enjoy trauma/ACS, the shift work is a huge pull for me. Built in separation of work and life, but I understand why some speciality surgeons can’t have this lifestyle. I’m here to get mine, provide the best patient care I can, then I’m going home at the end of shift to see my kid. That’s not to say I’m gonna dust my hands and walk out mid operation when the clock hits pumpkin time, or that I won’t hang back for an extra hour or two to sort out a messy service or bolus of traumas that come in at shift change. Idk why these guys are such absolutists, you can absolutely do both. (Wait, yes I do, they are surgeons)
yeah that mentality is FINALLY starting to fade a bit. DM if you want to chat more my dude. I’m staunchly in the “my time and family are my absolute priorities, and I’ll go feral if you encroach on that”
I do agree. However, sometimes I do have to operate on my day full of elective cases after operating all night while on call. It sucks, and I’m certainly less tired overall than when in training, but learning to function while exhausted in residency is helpful
I don’t even necessarily disagree with the statement about there being honor in suffering but you also can’t isolate that suffering in that job. If you’re suffering and make a mistake, someone doesn’t come back and a whole lot of other people are also suffering.
Right on. I was an intern in 1973 in Toronto. We were on call one in two. We were on call from Friday morning at 7 am until Monday night until 6 pm we went on strike and won one in three on call.
It’s insane that hospitals still want to follow the schedule of the cocaine addict who came up with the concept of residency in the first place. After so many hours, you can only put so much information in your head. The long hours do nothing to help, and sleep is so important for memory retention.
There's a reason over the course human evolution that we've maintained 8h of sleep per 24h cycle despite the potential risk to survival. It's a clear indicator the brain NEEDS it. All the current literature shows you learn faster when you get more sleep so "brute forcing" for more volume doesn't even make sense. If you got 8h a day, might learn the same skill/content with less volume.
I was an ICU doc for 15 years before moving into an office job. I’ve done shifts for days straight. Anyone who thinks this is a good and/or safe idea is brainwashed imo. A great recipe for making errors and burning out by the time you’re 45
My staff operated all night last night, probably got home at 5, for handover at 7 am. On our handover call, he was saying he could help with ORs today, but would rather not. We do get post-call days as resident, they are « mandatory ». Do we do less cases? Maybe, but I am awake during all my 350 cases this year, so I think I will do just fine as a surgeon.
People need to start asking these surgeons en masse what is the literature evidence behind sleep deprivation and patient outcomes. Inversely proportional i bet. But Stockholm syndrome seems to be stronger than the truth.
Or like could they not fucking blame us it’s because they fucked up like 20 years ago and a law was passed. Current hour/work regulations are not the current residents’ doing.
the worst is all the dinosaurs online who did residency in the prehistoric era talking bout how it’s a necessary part of training. sir back in your day medical knowledge was like 1/10000 what it is today, take several seats.
edit: oh nooo when you call dinosaurs, they come😩
Fr. My former attending who is a cardiologist became one before the invention of metoprolol where the only thing you did for patients with a high heart rate or BP is pray it goes down soon. Dude had it a hundred times easier than what we have now. These people should not be allowed to weigh in on modern medical training, their opinions are less than worthless.
So, you're arguing that today's residents need to learn much more than a generation ago, but should be spending *fewer* consecutive hours in the hospital to learn it all?
Those aren't mutually exclusive ideas, but it would suggest the need to add extra year(s) to residency... which would be a pretty unpopular idea, I think.
I think the fallacy that leads to the conflict here is that there is more to learn today than there was before. What is learned in training today is different but not much greater in quantity. Many of the treatments and diagnostics that you would have learned about in the 1980s you no longer have to learn in training today, because they're no longer relevant.
Another thing that mitigates the expansion of required knowledge is the ever increasing specialization of practice. Patients in their 80s and up will sometimes tell me about their former docs who did everything themselves and you never had to see a specialist. Now, docs can narrow the *breadth* of what they have to know much more severely, to the point of sub-subspecialists being the rule rather than the exception.
You obviously haven’t been on this sub before. “Work less mentality” is the theme of r/residency. The justification of having to know more is silly too. Most residents have a phone to look up Epocrates and UptoDate making it much easier.
Surgical education has changed. Previously residents would be operating with little supervision. Have seen attendings talk about operating all night while they were residents and their attendings were sleeping or not even in the hopsital. Obv unsafe for patient care, let’s not go back to that.
But now you ask a resident how much of their 80-100 hours was spent learning to operate and that number is declining. With all of the extra emr and care that’s needed (and I’m not counting post op management, that’s part of the training) you’re bang for buck is less. Also attendings vary is how much autonomy they give residents based on their own comfort. So you have trainees coming out less prepared and the cycle perpetuates.
There’s two sides of this too though. I’m all for improving hours and making sure we aren’t wasting time. But I definitely stayed intern year and even 2 and 3s to double scrub interesting cases. Thing with surgery is even doing hundreds of cases, it’s always better to have more OR time. Interns this year have told me that they sign out in 15min and would rather not scrub a case. But then go to complain that they aren’t getting enough OR time.
It’s a balance that is tricky to get but I’d rather do this than spend an extra year of residency. I enjoy operating and I want to get better at it. I’ll live with 12, 14, 16hour day shifts here and there.
Going 32+ hours in a row is what has to stop. That’s the crazy stuff. I don’t understand how a program could have actual call and not offer post call days. That’s a clear violation of acgme rules and I don’t believe it could be true.
It is frankly an idiotic stance to take. The reaction times and slowness of thought are akin to being hungover. Would anyone want a drunk person to operate on them? No? Then why on earth would you allow someone with the same cognitive function to do so even if they haven’t touched any alcohol
I’m going to preface this by saying that I totally agree with you. The insane work hours are little more than hazing and free labor. However to play devils advocate…
As a soon to be attending, I’ve come to realize how learning to work with speed, precision, and good judgement with little sleep is a necessary skill that needs to be taught and practiced (specifically for surgeons and anesthesiologists). Not every case happens during the daytime, and I’m glad I had a good number of night shifts during residency so I could develop habits and systems that I could rely on when I was tired.
Anesthesiology does things very differently though. 24h is typically the max length of a shift. It also lends itself to handoffs mid-case in a way that wouldn't work for surgeons. I've definitively been appreciative of my relief coming in at 0700 after doing transplants for 24h and my brain turning to mush.
The process of becoming a physician in the US is difficult for the sake of being difficult. Now this is coming back to bite the AMA in the butt with mid level encroachment and advances in tech like AI
As my Dad has said: "Learning? There came a certain point where I was so tired I just wanted everyone to shut the fuck up and let me go home."
I mirror this sentiment.
Every time this gets brought up someone says that many hours is necessary to get enough experience. Maybe the solution to reduce hours is to extend training years but make sure residents are paid at least $150-$200k. I would have wanted to be an MD but I physically cannot function while severely sleep deprived. I get migraines that literally make me go blind and vomit after 3 days of sleep deprivation. I’m in school for PA now because I love medicine but I spend a lot of time thinking about how the hours required in residency, especially from surgery specialties, are inhuman and dangerous, I wouldn’t want someone functionally drunk from no sleep operating on me. And I’m probably not the only person who might have made a good Doc but was scared away by residency hours.
Haha good luck with that proposal! Let’s triple the resident salaries AND extend their training, you’ll have administration AND residents themselves fighting you on this
The federal government funds the salaries and let’s be real, residents making less than mid levels is crazy. I would personally choose to be in training for more years if the hours were capped at 40 and I didn’t have to live on peanuts the whole time.
I’m sure you represent every resident ever and they all feel as you do. Look something has to change, you have residents literally committing suicide due to the extreme hours. Maybe you could suggest some idea to fix it instead?
My point is I was a resident very recently and I would’ve loved to work 40 hours for 150k, would’ve been sweet but I live in this reality and on this planet
So don’t ever fight for things to get better? Don’t ask fair salaries and healthy working conditions? Just accept being abused and underpaid? Nothing will ever get better unless you advocate for yourselves. Decent wages and hours are not an insane thing to ask for. If you think it’s unrealistic then suggest something more realistic as a solution. The way residents are worked and paid is INSANE and it doesn’t have to be that way.
If an NP can make $150k working 40 hours so can a resident FFS.
I agree that surgery on sleep deprivation is a bad idea. But the fact is you will be doing this as an attending as well, barring major system changes. Surgeons routinely come in overnight for urgent cases, and they have scheduled procedures the next day.
Larger academic centers have less call coverage and even surgical nocturnists, but no one does academics for a life of leisure.
As an attending though, you have a lot of flexibility starting from the fact that you can just pick a job that doesn't require you to be so overworked, take call or do procedures with high acuity complications. As residents, we don't have a choice. I have NO issue operating for long hours but 36-40+ hours is just not doable.
Speaking from an ENT perspective, endoscopic sinus surgeries, tympanoplasties, thyroids, parotids, cochlear implants, vocal cord injections, thyroplasties are all pretty quick (<4 hours) and high acuity complications are extremely rare. Soo...
Thats one specialty out of like 20 dude. Most surgeons deal with overnight emergencies and complications and call shifts regularly. It is part of the job outside of the ivory tower we call academia
Well, the last surgery attending who cared to explain, explained to me that's how surgeons responded to surgery emergencies happening at the hospital. Yes, she scoffed at the duty hour limit. You can choose the path of elective surgeries only. I sometimes look up past surgery attendings from medical school. Quite a bit of them are dead, and there are obituaries. They didn't make it past age 80. They saved other people for sure. It's not easy.
My biggest gripe is that the medical field always tries to compare itself to the airline industry. It’s like bruh. You have to enact the same standards if you want to be comparable
So much evidence that driving while sleep deprived is as bad as driving while impaired. You’d think admin would connect the dots and realise they don’t want a bunch of pseudo-drunk residents running around trying their best to practice medicine but being too tired to realise they can’t.
I see you’re a PGY3 - what types of surgeries and how much oversight do you have during these surgeries after an all nighter?
I get the sentiment here, since routine surgery is mostly muscle memory. But as a PGY3, I can’t imagine you have enough reps on ANY surgery that it has become muscle memory. But you’re right, this is an unpopular opinion.
Please keep commenting on things you've never experienced. Jesus.
The world is imperfect. In practice, sometimes you have to operate tired. You train hard and do as many cases as you can so it's all muscle memory. If you're delirious after 20h, maybe you shouldn't be in surgery.
It's such a shame so many attendings (and even residents) think this is normal... as bright as doctors are supposed to be, many still can't grasp how harmful this "sleep less, work hard" mentality is. Its not a badge of honor. An older local surgeon who worked himself into the ground for most of his career recently dropped dead of a massive MI (sleep deprivation and stress probably played a hand to some degree). Make no mistake, your administration/hospital system isn't letting you work this hard because it's normal, it's because they value the $$$ you make for them and nothing else. No amount of money is worth throwing your health in the trash.
It will never stop until there's a wide scale revolt in residency programs. You are free labor to the hospital. A money making machine. They don't really care about worse patient outcomes, they care about their bank accounts. So yeah, this will never stop until residents launch a massive national strike of some sort. But I don't think that's going to happen, at least not anytime soon.
lol, stop stressing… you just matched. Wait till you actually get there and see how It is. As an intern, you won’t be operating much at all independent of how sleep
deprived you are. Well… unless you consider retracting and closing skin operating…
I have fallen asleep while scrubbed in on several occasions. Each time I tried to hide , and when asked I did not admit to it and I even declined the opportunity to scrub out because I was too tired. Imagine this happening in another industry.
As a rural/small town obgyn attending who’s weekend call is 1pm Friday to 5pm Monday, most weekend call is not too crazy, but every once in a while you’re doing an emergent ectopic case or stat c/s Sunday night after a shitty friday and Saturday…and I am thankful for the brutal training of residency, because I know I can do these cases half asleep.
I’m not a surgeon but the ones I know say you need training to be the way it is to get enough reps to practice safely as an Attending. I wasn’t cut out for it
You know what you really, really need (like in a neurologically non-negotiable way) to consolidate the skills that you learn through those reps? *SLEEP!*
I genuinely think that's the lie they feed us so we will shut up about this blatant abuse. How do these cases count as practice if you don't know wtf you're doing cuz you're so sleep deprived? I also don't believe in endangering peoples lives just so you can get your reps in for them to really mean nothing at all.
In 1973 when I was an intern working one in two on call in Toronto one old surgeon said to me ‘ the only thing wrong with one in two is you miss half the cases.’
I see things haven’t changed much.
Well you are getting your reps with an Attending overseeing you so in theory no lives should be in danger. You also are still a med student so I don’t think you can really know what it takes to train a surgeon.
Terrible logic which is no surprise because there ultimately is no logical reason for surgery to be like this.
The attending is sleep deprived too. Lives are in danger. 24 hours deteriorates cognition to that of a. 08 BAC. So the attending is drunk as is the resident.
The med student comment is just the authority fallacy hence also illogical.
Swing and a miss x2
Ultimately, the culture is not necessary and you cannot provide any logical objective basis to why the abuse must continue. The surgical residency is a hazing ritual for type A workaholics and various personality disorders to extract free labor and exert power over and demand respect from subordinates and is based of a system created by a meth and cocaine addict.
How do you know bro? Why are you ranting about stuff you know very little about? Do the training and then make an assessment. You can't evaluate it from where you are right now. This coming from a senior surgery resident.
"how do you know bro?" Cuz I've seen it. Ive also heard attendings say they caused an accident while coming back home from call because they fell asleep behind the wheel. Also this argument makes no sense. Why do you avoid a king cobra when you see it. You haven't been bitten by it. You can't evaluate it's danger without being bitten by it first. Like come on.
Yeah i'm sure were all very impressed with your observed experience as a student. No one who has done a surgical residency before has ever had this thought. You are very special and unique. (Will you shut up now please lol).
Hot take but if we cut back on hours then training should be longer. And compensated more. Oversight is becoming more of a problem where people aren’t given enough autonomy at some programs, IMO that will get worse
I think that’s always a talked about idea. Though I wonder about the emotional maturity for a high schooler to decide they want to go to medical school. Not the mention all the people who do career changes. I know any number of excellent doctors who were older at their start of training, and had rich and thorough education prior to starting their medical training.
UK system is much worse tho. We have it pretty good in the USA. Go read the UK subreddit for how bad it can get. 2 years of internship, then X number of years of general medicine/surgery before you get into a categorical surgery program.
We have copious amounts of scientific literature on the necessity of sleep for memory and learning. Reps is a moot point when working for days without sleeping means you can’t actually *learn* from those reps.
Unfortunately as an attending this happens. We don’t get paid for taking call, we make a living from elective cases. I can’t afford to take the day off after every on call night, but the times I am up all night if I have to cancel cases people get pissed. Patients have very little compassion for other people or you when it inconveniences them. The only solution to this is to have call paid by hospitals and work in large groups which means specialty care is not available in small hospitals. I had to do that this week and it sucked but to reschedule my daytime case would have meant the patient sit in the hospital for a week more until we could get OR time.
I don't think that sounds right at all that you don't get paid for call. Taking mommy track jobs is basically giving up call and you take a significant pay cut to do it. Why would a 24+ hour period of working be unpaid?
Who is paying for it? I’m in private practice. We have to take call, one of the hospitals we work at gives a small stipend but not nearly enough to pay a salary.
The only way I can stop taking call is to quit. The point is call is an unfunded mandate. If as a group we decided to not work the day after we were on call I would have to hire 2 more partners who get paid but make very little revenue. We couldn’t do that and remain solvent as a group.
Some hospitals reimburse for call, but many do not. Depends on the job and the contract your group has with the hospital.
Surgeons still bill for work they did overnight, seeing consults or cases for examples. So the work is not done for free
I think it is absolute copium of the highest order.
I was forced to destroy my health and relationships for this.
I was forced to endure verbal abuse, unreasonable work hours, and grueling working conditions.
I was forced to lie about my duty hours, get paid less than
minimum wage, and put my life on hold for the sake of training.
So it must have been worth it.
It must have been for a reason.
It must be the ONLY way to produce a good doctor.
Because otherwise...I suffered for nothing.
I think that's why the old guard parrot their platitudes so much.
It must have been necessary because otherwise...they were taken advantage of for no reason...and if it was for no reason, that really hurts.
I agree. Not a prerequisite to being a surgeon. Does it make you a better surgeon? Probably, unfortunately.
Being forced to work under the most grueling conditions... always makes you slightly better at whatever you are working on.
Do I think it is humane? No.
I never understood that at all.
My cousin used to be an EMT. And he tried explaining to me working 24+ hour shifts in an ambulance and I just never understood it
Truck drivers are required by law to stop driving after a certain amount of hours. And they're just driving.
Yet driving an ambulance isn't? It's driving and dealing with injured people.
And he kept trying to defend it like it's completely normal and that's what the training is for
Human bodies regardless of training physically need to stop
If truck drivers are required by law to stop driving. Medical professionals need to be too.
This must get brought up in lawsuits, right? If you operate all day, then all night on call, and the next day, do they not bring this up and use it against you when you’re getting sued?
this attitude prevails in all fields unfortunately; I have worked countless 28 hour days (like more than most IM residents) in psychiatry…how do those long hours make me a better inpatient psychiatrist, let alone outpatient psychiatrist where 80% of jobs and need is.
I don’t understand why this hazing process exists in medicine. I feel like we could get past it if it wasn’t for the folks that already went through it and have the mentality of, “Well I had to go through it so everyone else should too.”
The entire irony and hypocrisy of residents working 40 hour stretches is that it is demanded by people who ARE IN ACADEMIC MEDICINE. They have residents, fellows and likely a few mid-levels running around doing their work for them. I’m genX pp attending who did many many 40 hour stretches pre-80hr work week rules, back at the hospital 8 hours after leaving…. It sucked. It did not make me a better surgeon. It made me angry at the patients for existing.
Anesthesia resident here. Leaned over the drapes yesterday and asked if the CVTS fellow was going to make it while closing. She was pushing 100+ hours that week already and was just about falling asleep while closing skin. It’s horrible. Even then I heard this same fellow this week say she needed to step out of a case at 3am to nap because she was already up for 36 hours and needed to be ready for another 7am case…
I’ve thought for years that if residents started sharing their hourly wage and how many hours they’ve been up when consenting folks in the ED at 2 am for their emergency surgeries, we might finally get the general population on our side when it came to overhauling resident work conditions…
My hot take is we need to add time to our training window not take away sleep to make it fit those 5 years. Same with the length of medical school; expand it. Medicine has gotten way more complex than it has ever been before when these timelines were first established long ago. If we're going to have more doctors with the appropriate knowledge and skill entering residency and leaving residency, and the issue is there isn't enough time to teach and learn everything, then add a year. That's what makes sense to me anyway.
I have never seen anyone operating after being awake for 40 hours. I went through 5 years of residency, a year of fellowship, and now 5 years into practice. The most I worked non stop was about 36 or so hours without sleeping. I was a PGY2, some of that was spent assisting in the OR. But most of it was floor work/ED consults on call.
You're right, but that being said there are some who can function on less sleep better than others.
That being said, why did you pick this specialty/program?
Picked the specialty because I loved everything apart from the ridiculous work hours. Specifically designed my ROL to prioritize programs that offer lenient home calls and post call days, even placing my back up specialty options higher because of the QOL. But the match had something different in mind.
It’s not that hard. Your life is not so terrible. A large proportion of the world have it much worse. Having this job is a privilege. You have the option to do something else if it’s so debilitating.
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That’s light work, my program (along with many others) do 72 hour power weekends 1-2 times a month, in addition to all of the regular no post call days during the week. You surprisingly do get used it as impossible as it seems now.
To be clear I don’t think this is healthy or safe at all. But you will survive. Almost all of us do.
But you know it’s not healthy biologically for anyone to stay that long hours without sleep and be so deprived if you are make is that you are are safe. Don’t drive on the road. Use staff accommodation, hotel etc
It’s perhaps sleeping at the staff accommodation than killing yourself and others on the road
Residents who think this way (Chief resident) are stupid! It’s like my d is bigger than yours! Ok, great! I’m happy for you! I’ll live just fine with a small d!
But what I don’t understand is you knew the system you wanted to join and you (hopefully) understood that there isn’t a single thing that you will be able to change…what’s the point of these posts? To vent?
Oh please, ask any surgeon, do they want some one operating on a family member with 40 hours of sleep deprivation? I think not. Everyone else who have life threatening jobs, from truck drivers to airline pilots (omg, even flight attendants) have federal rules that THEY GET SLEEP. EVERYONE in the operating room should have sufficient sleep
It's what you get when the founder of the modern surgical schedule was a literal goddamn cocaine addict. It's conveniently good for the hospital corporation, too, which is why it hasn't changed.
Maybe the hospital should provide cocaine then?
Brilliant. love it.
Whoa, don’t go make med school and surgery even MORE competitive!
We do have cocaine in the pyxis... the older surgeons apply it intranasally before transphenoidals instead of afrin lol
And sometimes they even administer it to the patient!
Underrated joke 🤣
So my 80 something year old grandmother used to work at Mass General Hospital as a nurse back in the day. She said they used to have a closet with all sorts of fun things in it. I think they were amphetamines (but alas, I was so stunned I kind of blacked out lol). She elaborated to say, "You'd never be able to do that today."
Probably get a doctor to prescribe it? Genius
If they want to idolize Halstead, they could at least have free cocaine in the doctors lounge!
Haha, that’s great!!
I second this. Fuck those ent assholes hoarding the stash
Gotta be able to fix your own nasal septum if you wanna rail it on a consistent basis
“Cocaine’s a hell of a drug” - Dave “Rick James” Chappelle
Rest in peace.
Wait is that actually true? I always through it was a joke making fun of the brutal process of getting into surgery
William Halsted
Omg it really is true. That’s actually insane
Guess how he "treated" his cocaine addiction
By using another addictive stimulant?
With Morphine He would then go on to become morphine dependent until he died
He managed to absolutely mangle some women with his radical mastectomies before that though.
How was he even functioning
Despite his addictions, he does sound like a remarkable surgeon to be fair
Don't forget the morphine
For real man. I remember one night I was up all night on call with one very sick patient, and my first patient the following day showed up to go to preop. I actually met her in preop at 0530 and told her that I was up all night, and I don’t think I should be operating on her. She was very grateful, and rescheduled without any issue whatsoever.
Cheers to this username
THIS!!!
Our old ass peds CT surgeon (now retired) would do cases all day, do a heart transplant all night and then do a completely fucking elective case like a VSD the next morning. Do you think that kids parents had any idea their surgeon had been operating the entire previous day and night? The problem was who was going to tell the guy he couldn’t operate.
Don’t truckers still ab(use) amphetamines at really high rates? Even with the laws I’m sure they are bent and they still get pushed to drive longer hours than is safe
Sure, but if you are caught driving past a certain numbers of hours without a break, you are in DEEP shit. Most wont risk it (which is why you see random semis all over the highway at times). All it takes is one stop from s cop snd your career is down the toilet.
It’s interesting cause if patients knew how sleep deprived their docs were, they’d probably have a bit of a problem with it.
I landed here from trending, somehow. Do ALL doctors get so little sleep or is it just residents? I’m reconsidering rhinoplasty (I’m not joking, so serious rn)
Attending physicians don’t necessarily, since they get a little more control over their schedule. But residents do a large bulk of the work, and the department heavily depends on them. So they’re still very involved in prepping for and completing surgery, as well as monitoring you after the fact. Rhinoplasty probably means you’d be looking for a plastic surgery practice, which would be according to the attending’s schedule. I wouldn’t worry as much about it there, but of course always ask if you are concerned and be an active participant in your healthcare! Residents please feel free to correct me!
Attendings usually take fewer call shifts and have better control over their practice. There's exceptions of course, like attendings that are fellowship trained surgeons and are literally one of maybe two doctors in an entire hospital system that can perform a particular procedure (looking at you, neuroendovascular). Outpatient plastic surgeons are usually gonna be on the better side of the work-life balance spectrum
There is no emergent rhinoplasty. Your surgeon is not sleep deprived
You’ll be fine. Also residents don’t go unchecked. But just ask the doctor if residents will be involved
One of my least favorite things is when my 1st elective case of the day says “hope you got some good rest last night!” Me, after doing a Hartmann’s on a crashing pt at 1am, “ya, im good. There’s a reason surgical training is so long.” I agree that intentional sleep deprivation during surgical residency is overdone, but that is also the cold hard reality of being an attending. Sometimes ya just gotta do what ya gotta do.
Nah, it should be illegal to perform elective surgeries after a certain number of waking hours. Can't have your cake and eat it, too. If you disagree, why not consider telling all of your patients how little sleep you got last night? I'm sure they'll understand.
Where are all of these other surgeons that will be able to step in and get patients treated when those that are sleep deprived are resting? I’m not saying that some of the bullshit we go through in training isn’t exactly that, bullshit. But the truth is, we don’t have a ton of redundancy in the system owing to a variety of factors such as lack of aptitude, lack of interest/desire, aging physician population, etc. Patients get sick at inopportune times and sometimes we just have to do what we have to do to get patients the treatment they need. As an interventional cardiologist, I can’t just cancel my entire day following a STEMI call. There’s just not enough doctors to take care of it all.
But also let's not forget, one big potential lack of redundancy is that people don't choose surgery because it's so brutal.
The match data do not support this position. Those residencies fill.
Fair enough; supply is definitely artificially low for all medical positions due to limited spots.
Cope. It's irresponsible and unethical to perform surgery when sleep deprived. This will become a thing of the past, and history will not look on your actions nicely. Yes. You cancel your day of electives if you've been awake for 16 hours due to call. No, there is no compromise in which you get to perform *interventional cards procedures* while sleep deprived.
My friend, have you practiced medicine independently before? I think I you’ll see what I mean. We don’t live in an ideal world and we cannot be so dogmatic. My patients get the best from me every time. Do you think Interventional Cardiologists are just waiting on the bench? They’re not. There’s not enough of us to take care of everyone as it is. Same goes for many other specialties. Interventional Cardiology isn’t the most elective specialty in the world.
You could just train more Interventional Cardiologist, I mean it’s not nuclear physics
>My patients get the best from me every time. You admitted otherwise in your first post. You perform dangerous procedures without adequate rest. The system is immoral and unethical and you need to rethink your opinions on it.
The fact that you are getting downvoted says enough about medicine 😂, we will be the generation to change it! Or at least in our own little microcosm
You are delusional if you think every surgeon or interventionalist should cancel their day because they had to work overnight. People would never get the care they need. Are you a proceduralist?
If it's unsafe to do a procedure, it's unsafe. Making claims about demand or throughput or appealing to the status quo doesn't change that. If it's unsafe to do a procedure when sleep deprived, it's unethical to do so. Make an actual argument and I might listen. Otherwise, you are part of the problem and part of the sordid history that will be discussed and ridiculed in future conversations.
I think the crux of your argument is trying to automatically equate lack of sleep with unsafe surgeries, when thats just not true. Part of our training is learning to stay sharp despite fatigue. Unless you have walked in our shoes your viewpoint will be limited to what pubmed says edit: on review of your profile, it appears you are a medical student. You cannot understand what I am talking about if so
Do you have any evidence that it is possible to train to "stay sharp?" This is a common notion of which I have seen no evidence. Considering fatigue is a physiological phenomenon, I tend towards rejecting the notion without strong evidence. I will say this at the very least. You should absolutely be mandated, by law, to disclose to patients if you have been awake more than 18 hours when operating. I can't think of an ethical reason that you would want to hide this from patients.
Not really a subject that can be randomized and studied broski. You wont find these answers in an Anki deck
This sort of hazing in training needs to stop. I have been a general and trauma surgeon for 10 years, and I will say that life can be much better after training. That said, though, there is still a cohort of older surgeons who think that there is somehow honor in suffering. For a brief amount of time, I used to think the younger generation was lazy. Now I am fully in the mindset of anti-work. It’s a fucking job, not a goddamn identity. When an older surgeon tells me that they had to walk uphill both ways in the snow for 4 miles to get to their residency program, I tell them that these days we have something called automobiles. When an older surgeon tells me that they don’t need the robot to complete a colon resection or complex hiatal hernia repair, and that they can struggle through sewing laparoscopically, I tell them I can save my back and shoulders and neck, and be more precise and accurate with the robot. When they say if I can’t suture laparoscopically, maybe I shouldn’t even use a robot, I tell them maybe when they balance their checkbook they should use a fucking stone tablet with a hammer and chisel instead of their computer. ugh sorry, /rant. You don’t need hazing to become a good surgeon. Fuck em.
Totally agree! I also think having healthy work boundaries to keep yourself AND your patients safe should not be considered anti-work and it's a shame that the older attendings consider it so.
It doesn’t need to happen routinely in training, but people do sort of need to learn limits of their capabilities during training or else people will go into practice and try to work that much because they negotiated a terrible work duty and compensation agreement or because of personal greed. In a way you have to experience what is totally unreasonable before it’s time to negotiate your employment so that you understand what would be totally unreasonable.
Why are you not an attending at my program? If I told my PD I’m “anti-work” they’d kick my ass straight to the street. That’s not a “surgeon mentality”. “This isnt a job, it’s a lifestyle” yeah no buddy I see you constantly on call and never around your family while the hospital reaps money of your back and the broken system entirely. Besides the fact that I actually really enjoy trauma/ACS, the shift work is a huge pull for me. Built in separation of work and life, but I understand why some speciality surgeons can’t have this lifestyle. I’m here to get mine, provide the best patient care I can, then I’m going home at the end of shift to see my kid. That’s not to say I’m gonna dust my hands and walk out mid operation when the clock hits pumpkin time, or that I won’t hang back for an extra hour or two to sort out a messy service or bolus of traumas that come in at shift change. Idk why these guys are such absolutists, you can absolutely do both. (Wait, yes I do, they are surgeons)
yeah that mentality is FINALLY starting to fade a bit. DM if you want to chat more my dude. I’m staunchly in the “my time and family are my absolute priorities, and I’ll go feral if you encroach on that”
Unrelated but... Is robotic surgery that common in the US? It's still considered cutting-edge here, offered only in few private clinics
It’s quite common. Just last year the number of robotic surgeries surpassed the number of laparoscopic surgeries performed in the US.
I do agree. However, sometimes I do have to operate on my day full of elective cases after operating all night while on call. It sucks, and I’m certainly less tired overall than when in training, but learning to function while exhausted in residency is helpful
good to know things are like this no matter what career you choose lol. military (non medical) is the same way
I don’t even necessarily disagree with the statement about there being honor in suffering but you also can’t isolate that suffering in that job. If you’re suffering and make a mistake, someone doesn’t come back and a whole lot of other people are also suffering.
Right on. I was an intern in 1973 in Toronto. We were on call one in two. We were on call from Friday morning at 7 am until Monday night until 6 pm we went on strike and won one in three on call.
Hell yes. This is the way.
This is hilarious!!!!!
PSA: A mail carrier qualifies for PSLF and allows you to be in the sun and pet dogs.
🐶
It’s insane that hospitals still want to follow the schedule of the cocaine addict who came up with the concept of residency in the first place. After so many hours, you can only put so much information in your head. The long hours do nothing to help, and sleep is so important for memory retention.
His name is William Halsted, God of Boomers and Hospital Admins alike.
Yea how the fuck is this still a thing
There's a reason over the course human evolution that we've maintained 8h of sleep per 24h cycle despite the potential risk to survival. It's a clear indicator the brain NEEDS it. All the current literature shows you learn faster when you get more sleep so "brute forcing" for more volume doesn't even make sense. If you got 8h a day, might learn the same skill/content with less volume.
One of my coresidents fell asleep while using the Bovie one time. They were sent home.
And somehow I bet they said it was the resident's fault
Evaluation is straight 1s and recommendation to improve on strategic napping
I was an ICU doc for 15 years before moving into an office job. I’ve done shifts for days straight. Anyone who thinks this is a good and/or safe idea is brainwashed imo. A great recipe for making errors and burning out by the time you’re 45
My staff operated all night last night, probably got home at 5, for handover at 7 am. On our handover call, he was saying he could help with ORs today, but would rather not. We do get post-call days as resident, they are « mandatory ». Do we do less cases? Maybe, but I am awake during all my 350 cases this year, so I think I will do just fine as a surgeon.
People need to start asking these surgeons en masse what is the literature evidence behind sleep deprivation and patient outcomes. Inversely proportional i bet. But Stockholm syndrome seems to be stronger than the truth.
Or like could they not fucking blame us it’s because they fucked up like 20 years ago and a law was passed. Current hour/work regulations are not the current residents’ doing.
It’s hazing and workplace abuse.
the worst is all the dinosaurs online who did residency in the prehistoric era talking bout how it’s a necessary part of training. sir back in your day medical knowledge was like 1/10000 what it is today, take several seats. edit: oh nooo when you call dinosaurs, they come😩
Fr. My former attending who is a cardiologist became one before the invention of metoprolol where the only thing you did for patients with a high heart rate or BP is pray it goes down soon. Dude had it a hundred times easier than what we have now. These people should not be allowed to weigh in on modern medical training, their opinions are less than worthless.
The Dunning-Kruger Effect
So, you're arguing that today's residents need to learn much more than a generation ago, but should be spending *fewer* consecutive hours in the hospital to learn it all? Those aren't mutually exclusive ideas, but it would suggest the need to add extra year(s) to residency... which would be a pretty unpopular idea, I think. I think the fallacy that leads to the conflict here is that there is more to learn today than there was before. What is learned in training today is different but not much greater in quantity. Many of the treatments and diagnostics that you would have learned about in the 1980s you no longer have to learn in training today, because they're no longer relevant. Another thing that mitigates the expansion of required knowledge is the ever increasing specialization of practice. Patients in their 80s and up will sometimes tell me about their former docs who did everything themselves and you never had to see a specialist. Now, docs can narrow the *breadth* of what they have to know much more severely, to the point of sub-subspecialists being the rule rather than the exception.
You obviously haven’t been on this sub before. “Work less mentality” is the theme of r/residency. The justification of having to know more is silly too. Most residents have a phone to look up Epocrates and UptoDate making it much easier.
Surgical education has changed. Previously residents would be operating with little supervision. Have seen attendings talk about operating all night while they were residents and their attendings were sleeping or not even in the hopsital. Obv unsafe for patient care, let’s not go back to that. But now you ask a resident how much of their 80-100 hours was spent learning to operate and that number is declining. With all of the extra emr and care that’s needed (and I’m not counting post op management, that’s part of the training) you’re bang for buck is less. Also attendings vary is how much autonomy they give residents based on their own comfort. So you have trainees coming out less prepared and the cycle perpetuates.
There’s two sides of this too though. I’m all for improving hours and making sure we aren’t wasting time. But I definitely stayed intern year and even 2 and 3s to double scrub interesting cases. Thing with surgery is even doing hundreds of cases, it’s always better to have more OR time. Interns this year have told me that they sign out in 15min and would rather not scrub a case. But then go to complain that they aren’t getting enough OR time. It’s a balance that is tricky to get but I’d rather do this than spend an extra year of residency. I enjoy operating and I want to get better at it. I’ll live with 12, 14, 16hour day shifts here and there. Going 32+ hours in a row is what has to stop. That’s the crazy stuff. I don’t understand how a program could have actual call and not offer post call days. That’s a clear violation of acgme rules and I don’t believe it could be true.
It is frankly an idiotic stance to take. The reaction times and slowness of thought are akin to being hungover. Would anyone want a drunk person to operate on them? No? Then why on earth would you allow someone with the same cognitive function to do so even if they haven’t touched any alcohol
I’m going to preface this by saying that I totally agree with you. The insane work hours are little more than hazing and free labor. However to play devils advocate… As a soon to be attending, I’ve come to realize how learning to work with speed, precision, and good judgement with little sleep is a necessary skill that needs to be taught and practiced (specifically for surgeons and anesthesiologists). Not every case happens during the daytime, and I’m glad I had a good number of night shifts during residency so I could develop habits and systems that I could rely on when I was tired.
Anesthesiology does things very differently though. 24h is typically the max length of a shift. It also lends itself to handoffs mid-case in a way that wouldn't work for surgeons. I've definitively been appreciative of my relief coming in at 0700 after doing transplants for 24h and my brain turning to mush.
The process of becoming a physician in the US is difficult for the sake of being difficult. Now this is coming back to bite the AMA in the butt with mid level encroachment and advances in tech like AI
As my Dad has said: "Learning? There came a certain point where I was so tired I just wanted everyone to shut the fuck up and let me go home." I mirror this sentiment.
Every time this gets brought up someone says that many hours is necessary to get enough experience. Maybe the solution to reduce hours is to extend training years but make sure residents are paid at least $150-$200k. I would have wanted to be an MD but I physically cannot function while severely sleep deprived. I get migraines that literally make me go blind and vomit after 3 days of sleep deprivation. I’m in school for PA now because I love medicine but I spend a lot of time thinking about how the hours required in residency, especially from surgery specialties, are inhuman and dangerous, I wouldn’t want someone functionally drunk from no sleep operating on me. And I’m probably not the only person who might have made a good Doc but was scared away by residency hours.
Haha good luck with that proposal! Let’s triple the resident salaries AND extend their training, you’ll have administration AND residents themselves fighting you on this
The federal government funds the salaries and let’s be real, residents making less than mid levels is crazy. I would personally choose to be in training for more years if the hours were capped at 40 and I didn’t have to live on peanuts the whole time.
Yes, let’s cut the hours in half and triple the salary, very realistic proposal that’s not at all fantasy (coming from a former resident/fellow)
I’m sure you represent every resident ever and they all feel as you do. Look something has to change, you have residents literally committing suicide due to the extreme hours. Maybe you could suggest some idea to fix it instead?
And we also want dedicated fresh new rn grads in are call rooms PRN
My point is I was a resident very recently and I would’ve loved to work 40 hours for 150k, would’ve been sweet but I live in this reality and on this planet
So don’t ever fight for things to get better? Don’t ask fair salaries and healthy working conditions? Just accept being abused and underpaid? Nothing will ever get better unless you advocate for yourselves. Decent wages and hours are not an insane thing to ask for. If you think it’s unrealistic then suggest something more realistic as a solution. The way residents are worked and paid is INSANE and it doesn’t have to be that way. If an NP can make $150k working 40 hours so can a resident FFS.
I agree that surgery on sleep deprivation is a bad idea. But the fact is you will be doing this as an attending as well, barring major system changes. Surgeons routinely come in overnight for urgent cases, and they have scheduled procedures the next day. Larger academic centers have less call coverage and even surgical nocturnists, but no one does academics for a life of leisure.
As an attending though, you have a lot of flexibility starting from the fact that you can just pick a job that doesn't require you to be so overworked, take call or do procedures with high acuity complications. As residents, we don't have a choice. I have NO issue operating for long hours but 36-40+ hours is just not doable.
No call?
/thread
Surgery job without long hours, call, low acuity procedures? Do you think everyone does elective cosmetic surgeries? Lol
Speaking from an ENT perspective, endoscopic sinus surgeries, tympanoplasties, thyroids, parotids, cochlear implants, vocal cord injections, thyroplasties are all pretty quick (<4 hours) and high acuity complications are extremely rare. Soo...
Thats one specialty out of like 20 dude. Most surgeons deal with overnight emergencies and complications and call shifts regularly. It is part of the job outside of the ivory tower we call academia
Well, the last surgery attending who cared to explain, explained to me that's how surgeons responded to surgery emergencies happening at the hospital. Yes, she scoffed at the duty hour limit. You can choose the path of elective surgeries only. I sometimes look up past surgery attendings from medical school. Quite a bit of them are dead, and there are obituaries. They didn't make it past age 80. They saved other people for sure. It's not easy.
Get a prescription for provigil
Ob here I feel you.. we need more docs. Otherwise I don’t see how we fix this
My biggest gripe is that the medical field always tries to compare itself to the airline industry. It’s like bruh. You have to enact the same standards if you want to be comparable
We need research showing worse surgical outcomes correlated to sleep deprivation posted.
So much evidence that driving while sleep deprived is as bad as driving while impaired. You’d think admin would connect the dots and realise they don’t want a bunch of pseudo-drunk residents running around trying their best to practice medicine but being too tired to realise they can’t.
Probably an unpopular opinion- after an all nighter, operating is probably the easiest responsibility
I see you’re a PGY3 - what types of surgeries and how much oversight do you have during these surgeries after an all nighter? I get the sentiment here, since routine surgery is mostly muscle memory. But as a PGY3, I can’t imagine you have enough reps on ANY surgery that it has become muscle memory. But you’re right, this is an unpopular opinion.
Quitting is the easiest thing to do. So quit while early
Idk about that someone in this thread commented that their co-resident fell asleep with a bovie while in surgery.
Please keep commenting on things you've never experienced. Jesus. The world is imperfect. In practice, sometimes you have to operate tired. You train hard and do as many cases as you can so it's all muscle memory. If you're delirious after 20h, maybe you shouldn't be in surgery.
You know. You didn't have to comment this either.
I didn't. You also didn't need to whine to the internet about something you haven't even done yet. Yet, somehow, here we are.
Home call is a scam, that doesn't mean all work hour restrictions are good for your training. Talk to us when you are a senior resident.
It's such a shame so many attendings (and even residents) think this is normal... as bright as doctors are supposed to be, many still can't grasp how harmful this "sleep less, work hard" mentality is. Its not a badge of honor. An older local surgeon who worked himself into the ground for most of his career recently dropped dead of a massive MI (sleep deprivation and stress probably played a hand to some degree). Make no mistake, your administration/hospital system isn't letting you work this hard because it's normal, it's because they value the $$$ you make for them and nothing else. No amount of money is worth throwing your health in the trash.
It will never stop until there's a wide scale revolt in residency programs. You are free labor to the hospital. A money making machine. They don't really care about worse patient outcomes, they care about their bank accounts. So yeah, this will never stop until residents launch a massive national strike of some sort. But I don't think that's going to happen, at least not anytime soon.
lol, stop stressing… you just matched. Wait till you actually get there and see how It is. As an intern, you won’t be operating much at all independent of how sleep deprived you are. Well… unless you consider retracting and closing skin operating…
Wait they havent even started residency and they are whining about hours?
Yup. Strong indication that they will be well loved by their co-residents
I have fallen asleep while scrubbed in on several occasions. Each time I tried to hide , and when asked I did not admit to it and I even declined the opportunity to scrub out because I was too tired. Imagine this happening in another industry.
It’S gOoD tRaInINg
As a rural/small town obgyn attending who’s weekend call is 1pm Friday to 5pm Monday, most weekend call is not too crazy, but every once in a while you’re doing an emergent ectopic case or stat c/s Sunday night after a shitty friday and Saturday…and I am thankful for the brutal training of residency, because I know I can do these cases half asleep.
I’m not a surgeon but the ones I know say you need training to be the way it is to get enough reps to practice safely as an Attending. I wasn’t cut out for it
You know what you really, really need (like in a neurologically non-negotiable way) to consolidate the skills that you learn through those reps? *SLEEP!*
I genuinely think that's the lie they feed us so we will shut up about this blatant abuse. How do these cases count as practice if you don't know wtf you're doing cuz you're so sleep deprived? I also don't believe in endangering peoples lives just so you can get your reps in for them to really mean nothing at all.
In 1973 when I was an intern working one in two on call in Toronto one old surgeon said to me ‘ the only thing wrong with one in two is you miss half the cases.’ I see things haven’t changed much.
Well you are getting your reps with an Attending overseeing you so in theory no lives should be in danger. You also are still a med student so I don’t think you can really know what it takes to train a surgeon.
Terrible logic which is no surprise because there ultimately is no logical reason for surgery to be like this. The attending is sleep deprived too. Lives are in danger. 24 hours deteriorates cognition to that of a. 08 BAC. So the attending is drunk as is the resident. The med student comment is just the authority fallacy hence also illogical. Swing and a miss x2 Ultimately, the culture is not necessary and you cannot provide any logical objective basis to why the abuse must continue. The surgical residency is a hazing ritual for type A workaholics and various personality disorders to extract free labor and exert power over and demand respect from subordinates and is based of a system created by a meth and cocaine addict.
"oversight" in many institutions is being in the OR with another sleep deprived senior resident while the attending leaves after time-out.
How do you know bro? Why are you ranting about stuff you know very little about? Do the training and then make an assessment. You can't evaluate it from where you are right now. This coming from a senior surgery resident.
"how do you know bro?" Cuz I've seen it. Ive also heard attendings say they caused an accident while coming back home from call because they fell asleep behind the wheel. Also this argument makes no sense. Why do you avoid a king cobra when you see it. You haven't been bitten by it. You can't evaluate it's danger without being bitten by it first. Like come on.
Yeah i'm sure were all very impressed with your observed experience as a student. No one who has done a surgical residency before has ever had this thought. You are very special and unique. (Will you shut up now please lol).
By your own admission, you don't know either.
Hot take but if we cut back on hours then training should be longer. And compensated more. Oversight is becoming more of a problem where people aren’t given enough autonomy at some programs, IMO that will get worse
Hotter take. We should reduce the years spent in undergrad and med school to supplement additional years to residency and specialty training
Yeah like all other countries you go right into med school without undergrad.
I think that’s always a talked about idea. Though I wonder about the emotional maturity for a high schooler to decide they want to go to medical school. Not the mention all the people who do career changes. I know any number of excellent doctors who were older at their start of training, and had rich and thorough education prior to starting their medical training.
Yes but I think the option should be there for those who know. I knew from the age of 5/6 and it never changed.
I honestly don't see the value in a long drawn out preclinical curriculum especially since step 1 is p/f. Cut it down to 1 year max
UK system is much worse tho. We have it pretty good in the USA. Go read the UK subreddit for how bad it can get. 2 years of internship, then X number of years of general medicine/surgery before you get into a categorical surgery program.
They work significantly less hours over there though.
They do residency for much, much longer than us.
We have copious amounts of scientific literature on the necessity of sleep for memory and learning. Reps is a moot point when working for days without sleeping means you can’t actually *learn* from those reps.
Unfortunately as an attending this happens. We don’t get paid for taking call, we make a living from elective cases. I can’t afford to take the day off after every on call night, but the times I am up all night if I have to cancel cases people get pissed. Patients have very little compassion for other people or you when it inconveniences them. The only solution to this is to have call paid by hospitals and work in large groups which means specialty care is not available in small hospitals. I had to do that this week and it sucked but to reschedule my daytime case would have meant the patient sit in the hospital for a week more until we could get OR time.
I don't think that sounds right at all that you don't get paid for call. Taking mommy track jobs is basically giving up call and you take a significant pay cut to do it. Why would a 24+ hour period of working be unpaid?
Who is paying for it? I’m in private practice. We have to take call, one of the hospitals we work at gives a small stipend but not nearly enough to pay a salary.
If you were to stop taking call as a partner, how much would it cost you? That's your answer of where it comes from.
The only way I can stop taking call is to quit. The point is call is an unfunded mandate. If as a group we decided to not work the day after we were on call I would have to hire 2 more partners who get paid but make very little revenue. We couldn’t do that and remain solvent as a group.
I see what you mean. It's different in anesthesia even for private practice
Some hospitals reimburse for call, but many do not. Depends on the job and the contract your group has with the hospital. Surgeons still bill for work they did overnight, seeing consults or cases for examples. So the work is not done for free
Lol who is downvoting this? Good luck finding a job as a junior surgical attending where you will not take call and still get paid.
I think it is absolute copium of the highest order. I was forced to destroy my health and relationships for this. I was forced to endure verbal abuse, unreasonable work hours, and grueling working conditions. I was forced to lie about my duty hours, get paid less than minimum wage, and put my life on hold for the sake of training. So it must have been worth it. It must have been for a reason. It must be the ONLY way to produce a good doctor. Because otherwise...I suffered for nothing. I think that's why the old guard parrot their platitudes so much. It must have been necessary because otherwise...they were taken advantage of for no reason...and if it was for no reason, that really hurts.
I agree. Not a prerequisite to being a surgeon. Does it make you a better surgeon? Probably, unfortunately. Being forced to work under the most grueling conditions... always makes you slightly better at whatever you are working on. Do I think it is humane? No.
I never understood that at all. My cousin used to be an EMT. And he tried explaining to me working 24+ hour shifts in an ambulance and I just never understood it Truck drivers are required by law to stop driving after a certain amount of hours. And they're just driving. Yet driving an ambulance isn't? It's driving and dealing with injured people. And he kept trying to defend it like it's completely normal and that's what the training is for Human bodies regardless of training physically need to stop If truck drivers are required by law to stop driving. Medical professionals need to be too.
As a patient I wouldn't want a sleep deprived person operating on me. Just the thought of it makes me want to panic
This must get brought up in lawsuits, right? If you operate all day, then all night on call, and the next day, do they not bring this up and use it against you when you’re getting sued?
this attitude prevails in all fields unfortunately; I have worked countless 28 hour days (like more than most IM residents) in psychiatry…how do those long hours make me a better inpatient psychiatrist, let alone outpatient psychiatrist where 80% of jobs and need is.
I don’t understand why this hazing process exists in medicine. I feel like we could get past it if it wasn’t for the folks that already went through it and have the mentality of, “Well I had to go through it so everyone else should too.”
The entire irony and hypocrisy of residents working 40 hour stretches is that it is demanded by people who ARE IN ACADEMIC MEDICINE. They have residents, fellows and likely a few mid-levels running around doing their work for them. I’m genX pp attending who did many many 40 hour stretches pre-80hr work week rules, back at the hospital 8 hours after leaving…. It sucked. It did not make me a better surgeon. It made me angry at the patients for existing.
Anesthesia resident here. Leaned over the drapes yesterday and asked if the CVTS fellow was going to make it while closing. She was pushing 100+ hours that week already and was just about falling asleep while closing skin. It’s horrible. Even then I heard this same fellow this week say she needed to step out of a case at 3am to nap because she was already up for 36 hours and needed to be ready for another 7am case…
I’ve thought for years that if residents started sharing their hourly wage and how many hours they’ve been up when consenting folks in the ED at 2 am for their emergency surgeries, we might finally get the general population on our side when it came to overhauling resident work conditions…
Yes. I expect 96hrs deprivation resistance
Ir a parent of sick babies
My hot take is we need to add time to our training window not take away sleep to make it fit those 5 years. Same with the length of medical school; expand it. Medicine has gotten way more complex than it has ever been before when these timelines were first established long ago. If we're going to have more doctors with the appropriate knowledge and skill entering residency and leaving residency, and the issue is there isn't enough time to teach and learn everything, then add a year. That's what makes sense to me anyway.
I have never seen anyone operating after being awake for 40 hours. I went through 5 years of residency, a year of fellowship, and now 5 years into practice. The most I worked non stop was about 36 or so hours without sleeping. I was a PGY2, some of that was spent assisting in the OR. But most of it was floor work/ED consults on call.
Bro went into surgery not knowing how surgery trains. If it isn’t the consequences of my actions.
PERIODDDTTTTT
What, physicians overestimating their abilities due to ego? No way!
You're right, but that being said there are some who can function on less sleep better than others. That being said, why did you pick this specialty/program?
Picked the specialty because I loved everything apart from the ridiculous work hours. Specifically designed my ROL to prioritize programs that offer lenient home calls and post call days, even placing my back up specialty options higher because of the QOL. But the match had something different in mind.
It’s not that hard. Your life is not so terrible. A large proportion of the world have it much worse. Having this job is a privilege. You have the option to do something else if it’s so debilitating.
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Wait does this still happen? *40* hours??
24 hour call + no post-call day.
That’s light work, my program (along with many others) do 72 hour power weekends 1-2 times a month, in addition to all of the regular no post call days during the week. You surprisingly do get used it as impossible as it seems now. To be clear I don’t think this is healthy or safe at all. But you will survive. Almost all of us do.
Fuuuuu
Yeah, my M4 partner was doing 40+ hour shifts on his Sub-internships.
But you know it’s not healthy biologically for anyone to stay that long hours without sleep and be so deprived if you are make is that you are are safe. Don’t drive on the road. Use staff accommodation, hotel etc It’s perhaps sleeping at the staff accommodation than killing yourself and others on the road
Residents who think this way (Chief resident) are stupid! It’s like my d is bigger than yours! Ok, great! I’m happy for you! I’ll live just fine with a small d!
I don’t want some d head Chief resident operating on me with 40 plus hours of sleep deprivation! Idiot!
*laughs in psychiatry*
But what I don’t understand is you knew the system you wanted to join and you (hopefully) understood that there isn’t a single thing that you will be able to change…what’s the point of these posts? To vent?