It’s true, and is published in a recent NEJM article.

Residents in Europe work about 56 hours per week, and after August 2008, they will be allowed to work only 48 hours.

Sleep medicine experts state that current training restrictions with maximum 30-hour shifts and 80-hour workweeks are unsafe for both patients and physicians. A fine balance is being looked at as to where the optimal line of patient care vs. physician work hours can be drawn.

If you compare what US residents work to residents in Europe, the poor US guys and gals are working almost twice as much.

I think further work hour reform is on the horizon, especially if favorable data comes out of the decreased work hours for European residents. Only time will tell but I think it’s a push in the right direction. 80 hours per week is still too damn much.

Via: [NEJM]

One of the things that they never mention when you are getting ready to go to medical school is what residency is about. Some people have ideas about what residency is, and some people are completely clueless. You can usually find these people on SDN with about 3 posts asking something like “How do I become a neonatologist”. That being said, the schools just sort of assume that you know what you are getting into. They have long sessions devoted to helping you get your ERAS (residency application) set up, your NRMP (matching service). They don’t mention what happens after you match (or if you don’t).

After you match or scramble, your residency position of choice sends you a packet of information that you have to fill out. If you have ever tried to join the military, the paperwork is basically the same. Some states are ridiculous about what they want, others noticeably less.

First, you have to apply for a limited license, so that you can practice as a resident. Each state has their own form for this, but they all have the basics. One state in particular has you list every single job you have ever had, along with all schooling, any periods where you weren’t in school or had a job, and probably your thoughts if you would like to put them on paper. They also make you go down to the local jail so you can be fingerprinted (twice!) at the same processing center as the other drug dealers. Sometimes you get to stop in the middle of yours so that they can take care of people with less patience than you. Sometimes you get spit on too.

You will also require at least 2 photographs of yourself, which, while not hard to get, are still a pain. Plus, you must pay for these things with either a cashier’s check or money order, because if anyone knows who it is that has bad credit, it is the future doctors of your state. Not that you didn’t already check them through NCIC with the whole fingerprinting thing. You also have to explain any and all criminal procedings, including but not limited to speeding tickets in excess of $100 (I’ve never had a ticket that cheap, who out there has?) Then you will need a state tax form (if you have state taxes), a federal tax form, a hospital code of conduct, a school of medicine (if so affiliated) code of conduct, a hospital confidentiality statement (HIPAA), employment eligibility verification form, a licensure policy, a Controlled Substances Act form, a USMLE/COMLEX policy (must take Step III by certain date), signing up for PALS, NALS, ACLS, ATLS, and last but not least, a hospital health screening form.

The screening form cracks me up, because it is the same form they use for the janitor apparently. One of the questions asks if you have or ever have had diabetes, then has in parentheses “sugar disease”. The really bad places don’t even give you envelopes for this stuff, and the extremely bad ones make you print out everything from an online site, but don’t tell you about it until an email shows up 2 weeks after the match. Not that I’m bitter or anything.

Last but not least of these is your “contract”. I put it in quotations so that you know that it really isn’t a mutual agreement as much as it is a mandate. You can either do what this piece of paper says, or you can not have a job and not apply for the match for the next 3 years. Seems about fair. Thankfully Congress prevented us from suing the NRMP over anti-trust issues by giving them a special exemption.

Not to dissuade anybody though, because it isn’t any different anywhere else you go. The biggest pain is that you will get to fill out all of this paperwork each and every time you start working at a new hospital. However, you can negotiate the terms of the contract after you are out of residency.

80 hours: Twice what a regular “full time” job requires you to work. Yet, 80 work hours per week is considered “too lenient” by some standards.

• There are 168 hours in a week.
• 80 hours is 47.6% of 168. You’re working for damn near half of the week.
• One day off in seven says you need to get your 80 in six.
• This means you’ll average 13.3 hours per day for 6 days a week.
• A first-year resident makes $38,000 – $42,000. Let’s use $40,000.
• With days off, a resident will work in the ballpark of 4150 hours per year.
• With a salary of $40,000 per year, this is equivalent to $9.63 per hour – before taxes.
• The federal minimum wage is $5.15 per hour.
• A resident’s salary is 1.87 times the federal minimum wage.
• The average citizen in the US sleeps 6.9 hours per night.
• After sleep and a regular work day, you’ll have exactly 3.8 hours per day to spend with your family, eat, shower, drive to and from work, buy groceries, pay bills, wash clothes, go to the bathroom, have sex, watch the news, read, study, cook, and live.

Have fun.

Some say you can still have a life while training as a resident. I tend to disagree, and here’s why:

1. Pager Matrimony
As a resident you’ll be married to your pager. The only time you’ll be allowed to turn it off is when you’re post-call. Even rarely after you finish your “shift” (on non-shift dependent rotations) will you be able to completely detach yourself from that dreaded beep machine.

Have you ever been in a conference and watch as how everybody in the room will reach down for their pager when one goes off? That’s really all the proof you need. Answering pages is typically a first priority for residents, as higher up attendings do not like to wait by the phone for more than 30 seconds for the call back.

2. Call and More Call
Taking call? Forget about leaving the hospital. Most training programs have strict rules that will not allow you to leave the hospital for food or running errands, especially when on call. This is one reason medical students are all too often used as food runners for residents.

If you have a must-do appointment somewhere, you’ll probably have to get into contact with your chief resident and request the time off. The difficulty that residents have in doing normal day-to-day things really boggles my mind. It’s not their fault, either. They’re at the hospital before normal working hours and stay until after normal working hours. When else are they to do the typical daily tasks that need taking care of?

3. Salaries
Residents are underpaid. The typical starting salary for an intern is somewhere in the high $30,000 range to the low $40,000 range. The maximum allowable work hours is 80. This equates to roughly $9.14 per hour using an average salary of $38,000 per year and 80 hour work weeks. We all know that most residents work more than 80 hours, so this number is just an estimate.

I’m willing to bet that some high-school dropout with a GED is making more than that working at McDonald’s somewhere. Does the promise of high salaries after residency training mean that residents can be underpaid in a monopolistic training environment without competition to naturally increase salaries? Hell no. But, as long as the NRMP is allowed to dominate the post-graduate training market, I don’t see salaries moving upwards anytime soon.

4. Time Off
Time off as a resident is nearly non-existent. Post-call days don’t count, either. Training programs have brainwashed residents into thinking that going home at noon post-call day is a day off. That’s crap. You go home and do what? Sleep?

If you’re single and live for the hospital, this might not be such a problem for you. But, if you’re like most people and have a life and family, this cuts into your personal time like a hot knife through butter. More time off needs to be given to residents.

5. 80 Hour Weeks
80 hour weeks are bullshit. If you absolutely love what you’re doing, 80 hours per week is nothing. Ask yourself this though: How many residents do you know that absolutely love what they’re doing? A small handful, at most.

Sure, limiting the residency work week to 80 hours was a huge plus for residents. Some of those poor people were working 120+ hours per week. The new rule essentially bagged them an additional 40 hours of free sleep time.

You’ll still run across those old-school attendings that think the 80 hour week is too lenient. Coming from a more hostile training environment, they think that just because they did it you have to as well. It’s the “I suffered, you’ll suffer” mentality

6. The Hierarchy
I discussed the medical training heirarchy a long time ago. It’s similar to that found in other manager-employee relationships, but medical training has found a way to take it a step further. Not only will you have to deal with your day-to-day routines and long work hours, but you’ll also have to put up workplace politics on steroids as well.

7. Inefficiency
Medical training is as efficient as the manual assembly of computers. Large scale manufacturing and corporate big business is efficient. Government jobs and medical training is not.

More time is wasted than is actually spent doing work. All of that time residents spend doing crap that’s better left for someone lower down on the food chain could better be spent at home or in the form of free time.

8. Inbred Social Life
Without time to leave the hospital and carry on meaningful relationships with people outside of medicine, you’ll be forced to treat residency as your primary social outlet. This is a dead end. While others are out strengthening more meaningful relationships, residents are forced to interact with whom they work with.

I don’t know about you, but most residents are not what I’d call a close friend. But, there’s not much you can do about it.

9. Contractual Employment
Residents operate on contracts. A new contract is signed at the beginning of your intern year (actually, when you are offered a spot during the match), and then each year thereafter.

If program directors do not feel you are living up to their expectations, they can terminate your contract. A resident who’s had a contract terminated for whatever reason might be hard pressed to find another program that will quickly pick him or her up.

That’s a pretty big gamble by anybody’s standards. It’s the system.

10. Becoming Them
The medical training process produces more of the same. All too often I’ve heard from physicians that used to love patients and their work who are now completely unhappy and wouldn’t do it over if you paid them.

This is probably the most serious consequence of residency training, as it has possible permanent effects. Personalities are changed for the worse, and all of a sudden you become them. You become what you hated so much during your third and fourth year of medical school and throughout residency.

It’s part of the process, and is the reason why the trend continues.

Maximum Security Prison
If you’re a nice, conditioned medical student that has been beaten into submission by the system, you’ll most likely be defensive about this post. However, if what I said above didn’t have a speck of truth to it, you wouldn’t have a reaction to it at all.

It’s really tough to throw away four years of your life and hundreds of thousands of dollars in debt when you suddenly realize that this isn’t for you, which could be considered another example of imprisonment via educational debt.

No matter what you decide to do, just be nice to the warden so he’ll let you go outside.