This is disgusting. No person should be asked to work this many hours. We need overtime laws to apply to every non-executive job. As a customer, I don't feel comfortable with the idea that my doctor could be that exhausted and as a human being, I feel like working someone like that is completely inappropriate.
Thanks Aaron for another insightful video. In discussions about residency work hours, almost everyone focuses on only patient safety and/or resident education. So when a study comes out that shows neither was impacted by changes in work hours or work schedule, people can use that to simply justify their original belief on the topic. However, what almost no one talks about is what is ethically appropriate for an employer to ask of an employee. Employees in no other profession would tolerate what residents have traditionally been asked to tolerate: 80 hr work week, 28+ hr shifts, no guaranteed breaks of any kind, abuse from superiors, constant threat of retaliation for speaking up against unfair policies/practices, and on top of all that, minimum wage pay. Using a study that showed no changes in patient safety or resident education as justification for readopting long resident work hours is like saying a study that shows child labor doesn't lead to increased child mortality rates means that child labor is perfectly ok. Residents are hospital employees, and should be given all of the rights and safeguards as any other employee, including fair pay (which would literally be 2x what they typically currently receive).
+Strong Medicine Burn out rates for residents approach 100% by the end of their residency. That should be a clear sign as to what should be considered an issue. The problem is that it's expensive to train a resident, and paying them more isn't helping the issue. I'd rather see more residency spots opening up to train more doctors with the expanded cash going into the system if we are going to spend than paying the current residents more money. Granted I do have a bias in the matter, I'm an MD who will likely never receive the privilege to go into a residency, after all.
I love what you said in the second paragraph about the ethics of the topic, not just the physical barriers and impacts on care. "However, what almost no one talks about is what is ethically appropriate for an employer to ask of an employee. Employees in no other profession would tolerate what residents have traditionally been asked to tolerate: 80 hr work week, 28+ hr shifts, no guaranteed breaks of any kind, abuse from superiors, constant threat of retaliation for speaking up against unfair policies/practices, and on top of all that, minimum wage pay. " This speaks volumes, why would an employer want to have employees working shifts possibly up to 28 hours? There are many large studies out there showing that a person staying up more than the suggested hours performs much much worse than someone who is well rested. An individual that has been awake for that amount of time let alone working, needs to have stricter limits on hours able to work. This fatigue of the caregivers can ultimately lead to unhealthy caregivers and more common errors in patient care. There are things that we do not want to see in our care facilities. The video mentions low pay for residents, therefore not making the long terrible hours really worth the pain they have to suffer. Also the unfair treatment, abuse from superiors, etc. This is supposed to be a very special training and learning experience for the future doctors. We want the process to be difficult and strenuous so that only the best get into the programs, but we do not want it to effect the care that is administered to the patients. Neither do we want it to effect the learning process that the residents are going through.
I simply don't understand why someone would want to pursue a profession in which one must work 80+ hours a week just to become career ready; I really appreciate doctors but that seems cruel. If a person is exhausted all the time that can't possibly be good for patient outcomes.
As a patient (and I am an end-stage renal disease patient, so I'm not a filthy casual who gets a cold once in a while) the shifts required of doctors and nurses are straight-up horrifying to me. Medical professionals are supposed to be modeling and recommending healthy lifestyles to their patients, but how can they do that if it's just expected that they sacrifice their own mental health for three years during a residency? Even the experienced, tenured techs at my dialysis clinic are expected to come in at 10:00am one day and work a 13-hour shift, then come in a day later at 3:30AM. While it didn't come up in the studies you mentioned, I'd be curious to hear patient reactions if they were told the resident treating them in the ER had been on duty for 27 hours. The bottom line is that this system is totally broken and needs massive reform.
+stormbob ED physicians tend to work in shifts, so they don't have to be on call for 12+ hours at a time. That's actually one of the perks of going into emergency medicine. But the hours do they work, it's almost non-stop adrenaline rush. I've done 30 hour calls with the trauma team before. Definitely some moments when I almost fell asleep in the OR, but it was otherwise nonstop experience. If you weren't up doing something, then you were sleeping in the call room.
+Dr.Smarty Pants I am sorry Dr. Smarty Pants, but I must disagree with you, more sleep is shown to result in far better performance and information retention. You would likely be twice the doctor you are now if you had gotten the rest you needed during your residency, not half.
Working 100 hours a week is not good for you, going home and looking up cases is fine though. Patient outcomes will not be improved unless we get residents down to 40 hours a week. The residents' feelings that they will be worse doctors is due to indoctrination, and should be disregarded. A longer residency with less hours would result in the same amount of practice without fatigue. There are many kinds of fatigue that do not relate to lack of sleep.
Yeah, that is a good point. I still think that 80 hour work weeks is unhealthy though. Saying that you personally know that working that hard is important is anecdotal and unreliable as it is difficult to correctly evaluate beliefs you are invested in from the first person. We will be unable to verify your claims unless we actually have residents try lower hours before they have been convinced they need more.
I think many people would be willing to try that if presented with the actual hours residents are working. At this point we do not know if it would decrease or potentially increase positive patient outcomes. I think the hour modifications we have already tried are not drastic enough to have made much of a difference.
Finally someone trying to address and at least talk about this issue that has been trivialized by medicine. Being attached to and being identified by your work and doing these grueling calls only hurts the self esteem of residents and fellows. Feeling under appreciated for all they do further adds to the icing on top of this melting cake! They start to underperform and take it as a chore, be less human, hardly engage in activities outside work, dissociate themselves from patients and come home from the most noble job with complete dissatisfaction. Do yourself a favor and never associate your self identity to the residency or fellowship you’re in, it’s only the time to learn and grow. Make time to enjoy life like every other 9-5er until these people figure out the right hours for you!
+photosinensis I'd like to hear an explanation of why that career and others must be unnecessarily difficult. If we produced more doctors, they could work normal work weeks.
+nonchalantd It's expensive to train, and most doctors do end up working a lot of hours to make ends meet with their debt with the falling insurance payments. The career path basically is in a death spiral.
+nonchalantd It's not about a scarcity of doctors. In fact, the situation these days is actually more like a whole bunch of med school students and graduates fighting for a limited number of positions/residencies.
James Sheppard Do you think the limited residencies are by design in order to give doctors leverage during salary negotiations to maintain or raise them?
+Evan Ales Naw, enjoy having a residency bro. I'm part of the 40 or so percent of IMGs that will never have that chance to make it into a residency. I can only look at you with envy.
+Evan Ales Medical school compared to college is like studying for finals almost every day. Residency is like studying for finals every waking hour 6 days a week for 3+ years.
Spitzenhund Trying to focus on going into other aspects of medicine. In the meantime work odd jobs. There really isn't much you can do with an MD without a residency. Most of my colleagues who doesn't match have no idea what to do either. Lol
Another issue about long hours is that it may deter competent and intelligent people from pursuing a medical career. This could cause the whole industry to suffer if there is a lack of skilled workers. However, I think it would be very difficult to find data to back this claim up.
I find it rather at odds that people can argue that employing more nursing practitioners and "mid-level providers", who typically have fewer formal education hours than doctors, is adequate, but also can argue that residents need long hours in order to become good doctors.
Here in Australia we have graduated beyond the ancient and backwards thinking that non-stop gruelling hours is somehow 'noble' and displays' commitment' (although I still think surgical trainees have a little further to progress on that front). I'm an ED trainee and I'm rostered onto 80 hours per fortnight, although I do do overtime. Sure, we see less and our training programs are significantly longer, but we're also much better remunerated and work/life balance is far better. Who cares if you're not an 'attending/consultant' by the time you're 30, when you're earning good money, work flexible hours despite still being a registrar?
+Tasnadian Not to mention, with the undergraduate MBBS degree you can still get here, we CAN be consultants by the time we're 30 without wanting to kill ourselves before reaching that point.
True! Although many universities are starting to move towards the graduate 'MD'. I think it's just a marketing plot to lure North Americans desperate to get into med school (ie. Canada) and charging them like 60k a year for it..
I agree! The undergradate model actually works really well, and doesn't force you to cram two years of theoretical knowledge re: anatomy and physiology into one!
Seems like the experiment shows that no change results in no change. How about a real experiment comparing say 60 hour work weeks to 80 hour work weeks
Working over 80 hours a week in a physically, emotionally, and mentally demanding job may not make a difference in patient outcome, according to these studies, but I'm sure it has an effect on doctor's bedside manner which is an important part of patient care. It also can't have a good outcome for the resident's either. Asking an employee to work 80+ hours a week for a less than desirable pay is outrageous. Most residents have to start paying back their student loan debt while they are only making enough money to support themselves. Some residents also have families, or want to have one. They already spent all of their time during medical school studying and doing clinical rotations. After all of this stress on them and their personal relationships they are expected to spend all of their time at the hospital during their residency. There are 168 hours in a week. If the resident is working only 80 hours a week, that leaves them 88 hours for themselves. If you let them sleep for 8 hours a day, they are left with 32 hours of their own time for the entire week. Yet people still wonder why there is resident burn out... Some of the residents may want to work these insane hours, or feel obligated to because it is "part of the job". Just because doctors are held to a higher standard does not mean they aren't human. They need time to themselves to relax and take a break from such a stressful job, just like everyone else. Also, just like it was said in the video, some residents think it is noble to be completely miserable during their residency. They need to understand that this isn't how it should be. Further, how can a doctor or a surgeon recommend a healthy lifestyle to their patients when they aren't living one themselves? Although I want to be a surgeon, I don't believe that working all of these hours in a week will help. I see it like cramming for an exam. Cramming studying into a smaller time span doesn't help you learn and retain information. Spending most of the week in the hospital for residency probably doesn't help learning either. Exhausted residents probably don't retain as much information. However, if residencies were slightly longer in total length but less hours a week, I wonder if there would be a difference in resident burn out and retention of knowledge.
I am a plastic surgery resident in Turkey now in my 18th month of training. As I began to the residency, I was working 30 days and 15 of them followed with night shifts (which is basically 36 hours x15 = 540 hours a month = 135 hours a week). As I grow older, such as now, I am working 30 days and 10-11 of them followed with night shifts. There is literally nothing noble about being "milked" by the system as there is a lack of surgeons who are trying to embrace the patients spoiled by the national healthcare system. What is funny though, after the COVID pandemic, many European healthcare providers were complaining about how harsh the conditions became after the pandemic, but how much they were working as shifts were seemingly plausible for us and now we are kind of on a vacation :)
Particularly as mental health issues are stigmatised quite badly in the medical health field, well, over here in the UK at least from what I hear out of people I know in healthcare ^^"
Yes! My aunt is a surgeon and uses intimidation to get her way. She definitely thinks you have to suffer to commit to anything. I'm older now and want to become a Dr. but now I'm terrified lol
I know how mushy my brain is after work 10-12 hours.. why are our doctors held to such a higher max? I work 60 hr weeks on my feet dealing with people (retail, yay!) and that drains me and creates crappy work/life balance.. Why should doctors in charge of my care have to have it so much worse? Say 12 hour shifts... would only mean a patient would see 2 different doctors/day during a hospital visit. A more rested doctor can mean a clearer mind, more accurate patient records and thus, making patient care just as good (if not better?) during doctor changes... Crazy....
NPR reported on this recently, and also seemed to take the study's perspective that these new residency regulations "didn't work" because evidently patient care and doctor education didn't improve. I was confused for the same reason -- didn't the study also prove that having residents work ungodly hours *doesn't* improve care or education? Are they really arguing that working those hours has no effect on these doctors' cognitive function and emotional regulation, as there's plenty of evidence sleeplessness and stress does, especially long-term? I wonder how many of these residents use stimulants to cope with this (e.g. Adderall, which could explain why their educational outcomes seemingly weren't affected).
In my opinion, the hours that residents and interns are expected to work are astonishing. This puts not only the patient in danger but the doctor as well. Doctors are supposed to exemplify healthy living and working 80+ hours a week and 28 hour day is not healthy whatsoever. The amount of sleep deprivation that doctors endure could lead to mistakes and the be harmful to the well-being of patients. If I were a surgical patient and I found out that my surgeon had been awake for more than 24 hours, I would not want them operating on me. I do not care what the statistics are working these hours is not healthy and potentially dangerous for the patients and the doctors. It has been proven that most doctors will more than likely suffer from mental health issues like depression which just adds to the stress of the job. Forcing doctors to take a day or two off will improve their personal well-being as well as the safety of the patients.
Antonio Giron yes in some places (like mine) labor laws and minimum wage or maximum working hours dont count for some because interns amd residents are regarded as trainees and not employees.
Can you do an episode on physician radiation exposure and cancer rates? I've always been curious if this was a risk factor for interventional cardiologists and radiologists.
I heard it used to be a big deal for interventional radiology, but now it's considerably better. They now have radiation exposure gauges to regulate and monitor radiation exposures. No doubt it's still a risk, but it's much better.
I'm in high school and am considering becoming a physician, but the prospect of 16+ hour work shifts in residency on top of the already strenuous medical school is rather frightening to me. Do people actually physically work the entire time they are in residency (all 16 hours), or is that just the "official" number? Maybe I should just go into engineering...
+Ahrk FinTey If you're interested in medical stuff but just don't think you could handle the demanding residency, consider looking into nursing, PA school, dentistry, pharmacy, etc. All are interesting medical fields that are still challenging in their own right but don't have the same kind of strenuous residency (though nursing hours can definitely be long, but not usually like this).
+Ahrk FinTey When I was in high school, I had no idea how being premed in college, applying to medical school, and what being a doctor was like. Now that I'm almost done with medical school, I would still tell my younger self to do it again. However, you will meet a lot of doctors who will try to dissuade you from pursuing medicine. I think the best advice is to give yourself the chance to try out a few careers before settling on medicine. If you can find yourself loving any other career, do that instead. Being a physician requires too much physical, emotional, financial, and psychological sacrifice, but it is also extremely rewarding as well. In short, study hard and keep an open mind. You still have a long way to go.
+CannonLongshot Residents are people fresh out of medical school. In Australia we call first year residents as interns and everybody after the first year as residents. US system is slightly more f*d up because they immediately go into surgical/medical in that first intern year, whereas we have a broader introduction to working years.
Wokanshutaiduo Snape Not fully true. For example, my friend is specializing in Interventional Radiology and he must first complete a year of broad internship before going into 4 years of residency. I think it depends on the specialty but most surgical specialties will involve a year of internship before residency.
Dr.Smarty Pants Yes its similar for us during the university years. During M1/2 its all theory based, plus the theoretical basis of Hx/Ex/Dx. Years M3/4/5 its all hospital based across varrious specialties, though not everyone does everything. The difference is that we still have undergrad models available so many of us go direct to M1/2 from high school, no premed degree beforehand. But being a student and being a doctor are different experiences entirely. In intern year we do a medical term, a surgical term and an emergency term, plus another two of our choice. Only then as residents do we choose a surgical, medical or a general stream. Then gaining a fellowship can be anywhere from 3 years to 7 years minimum! (3 years for me as I'm going into general practice)
The conditions and hours that doctors must work is extremely dangerous for not only the patient they are attending to, but also the doctor themselves. In order to become a doctor, I have heard several stories of the stresses and lack of sleep medical school entails. Doctors wear this stress and sleeplessness as a badge of honor, like they are sacrificing themselves in order to save others. Are they really going to be capable of helping others if they can't even help themselves? It is extremely unhealthy for doctors to work shifts on no sleep, let alone 80+ hours a week. With this intense amount of work will come mistakes. If mistakes could be prevented just by taking some time off to sleep or even just some time for the doctor's themselves, I believe it is extremely beneficial. Despite what humans believe, doctors are humans too. The healthcare system is treating them in an inhumane manner and I believe it is wrong. Imagine if you were the patient and you realized your surgeon has been working a 24 hour shift. I would feel extremely uneasy fearing their sleep deprivation has the potential to influence their focus on my procedure. Mistakes are made when people are delirious. I liked how the video pointed out along with physical health problems, doctors will more than likely experience mental health issues, like depression. It would be extremely hard not to enter depression if one is worked ragged almost every day of the week. For the future, we should want our doctors to be excited about surgery, medicine, and helping patients recover. We don't want a doctor who is burned out and lacks a passion that they may have once had. Taking more time for themselves, I believe doctors and patients will both benefit.
The study is comparing 2 utterly ridiculous circumstances and trying to see if one is better than the other. NEITHER is good. Seriously, cap the hours at something normal people can function under. 60 hours a week should be the cap. 15 hours A DAY should be a maximum. We need to rethink the entire medical school/training process. 4 years of undergrad and then medical school is time wasting. If we made it one step - Make the pre-med stuff part of the Medical curriculum and we could have longer less grueling residencies.
+am2schmarvelous I don't know... from my experience in a health-related field, I'm amazed medical school is even enough to cover the entire field sufficiently in a way that can be retained. Every year we add more and more knowledge to our understanding of human physiology and pathology... and that's one more often very complex thing medical students must learn. If anything, putting more more stuff in pre-med undergrad might help. If you're majoring in pre-med, maybe streamline the general education so you can start getting a lot more advanced sooner, e.g. one year of gen ed, 3 years of increasingly advanced biology, chemistry, molecular, etc.
+mar9en It works for us down in Australia. My med degree started immediately after high school and was 5 years long. Am a PGY2 resident now, and our weeks are typically 40 weeks. American residencies are insane.
I wouldn't trust myself stacking shelves at the end of an 80 hour week, nor at the end of a 12 hour day, and yet Aaron seems to be comparing the practice of working 12 hour days with LONGER hours... Would it not be useful and meaningful to look at the patient and physician outcomes for shorter working hours?
In our country, our interns and residents work 100 plus hours a week in tertiary and public hospitals. When I did training in one of the maternity hospitals, we had 10 residents and 10 medical students in 24 hours delivering between 60 to 80 patients. It's definitely not healthy but major mistakes are rare because of proper supervision. Sorry to say this, but western and especially American doctors are very spoiled. There are actual studies that IMGs or International Medical Graduates make less errors.
I do not think think residents should be working more than a 12 hours shift, even if they have to explain the whole thing all over again to another resident or doctor. if you are saying that they might be in the middle of a surgery when why would they start it to begin with. I would not comfortable, mentally and humanly knowing my doctor is perhaps exhausted. and I am not a person who just stops by a hospital when they get a cold or a sore throat, I think people nowadays should be able to recognize or diagnose themselves with those. Plus, another argument is that it would affect the doctor's or resident's mood or mentality which will affect their reputation badly, even if they did diagnose their patients wrongly, a patient is more likely to forgive a doctor if were nice or treated the patient well. as I said, long hours will affect their moods which will affect their performance which affects their reputation."
KinKinOmar 1) remember, there are no work hour restrictions after residency. 2) surgery duration is estimated but never guaranteed; if unexpected findings arise and add 4 hrs to the surgery, closing up & ending the surgery because it would extend past a theoretical shift limit isn't even a consideration in the decision-making process.
There needs to be a cap on all job shifts. 13 hours and then YOU GO HOME, PERIOD and then you can not work that long again for like 2 days. Health and Sanity are far more important and I'm not just talking about doctors here.
+Scheefinator For ongoing schedules, I'd say that sounds like a good policy, but there are some situations where it wouldn't work. When it comes to something like disaster response, you might need all hands on deck for 112 hours a week, but you're only doing that for like two weeks.
John Harvey Nope, hire more people to compensate for those times. I do not think it is acceptable for any individual to work over 14 hours days, period for any reason. And I think that asking someone to do so is unethical, especially when you can hire more people to compensate.
Scheefinator > Nope, hire more people to compensate for those times. -- It doesn't work that way. Personnel and funding are finite, and there are logistical, operational, and training-related reasons why you can't just "hire more people". > And I think that asking someone to do so is unethical, especially when you can hire more people to compensate. -- ... and when you can't? When you've hired all the people you could get and it's been 14 hours but there are still people buried under rubble, do you yabba-dabba-doo your way back to your tent or do you keep digging?
John Harvey Stop sliding this into extreme territories like that. I told you, all of your reasons besides ones of ACTUAL emergency are the results of greedy corporate profit and the unwillingness to spend money. I don't want to hear such excuses, don't fall for this shit, they can always hire more people, they just won't. Can't cut into those precious 100k plus executive checks in order to make work conditions better for people, folks. Nope, wouldn't want to do that. I told you my stance. It will not change.
Scheefinator >Stop sliding this into extreme territories like that. -- I'm picking "extreme territories" because you're trying to apply an absolute rule to all cases (which is rather extreme, don't you think?), and a rule that doesn't account for edge cases is a bad rule. Thirteen hours is not extreme. I'm not even talking about people working for three or four days straight without sleep in the case of something like 9/11. I'm talking about stuff that happens all the time. >I told you, all of your reasons besides ones of ACTUAL emergency are the results of greedy corporate profit and the unwillingness to spend money. -- You act as though emergencies are rare, but they happen pretty regularly and need to be accounted for. Emergency preparedness is built into every part of a functioning society (your workplace has a fire extinguisher, right?), so a rule that tries to rule over the entire workforce had better account for it as well. >I don't want to hear such excuses, don't fall for this shit, they can always hire more people, they just won't. -- Hire more people, you say? Why didn't I think of that? Could it be that things aren't that simple in the real world? We do not live in a post-scarcity economy, so the labor pool is finite, infrastructure is finite, and funding is finite, so when you have a small number of workers suddenly facing a fuck-ton of work... well, somebody's going to have to actually work for a living. Mobilizing personnel takes a lot of coordination, a lot of time, and a lot of money. Workers can't be conjured from the aether, so "just hire more people" is not a solution. Each of them has to be trained, tested, certified, equipped, kept track of, and in the cases I'm referring to they also need to be dispatched, boarded, fed, transported... and you're talking about multiplying that. There were more than seven thousand people on the 2014 King Fire (not a record, by the way), and they all needed a place to pitch their tent, food to eat, and somewhere to shit, so I don't know where you'd propose to put the extra couple of thousand you'd need with your proposed candy-ass schedule or whose money you propose to spend.
The divorce anecdote was showing a bit of dark humor. The idea that sacrificing your personal life and making yourself miserable has been enforced in many people from: students, veterinarians, teachers ect., as it commonly seen that the person is sacrificing their own happiness for those of others. Veterinarians do the exact same thing as GPs... and they get paid less. -.-
Why did it even become a thing for doctors and nurses to have ridiculous shifts? Why cant they just employ the same methods as other industries that require 24 hr up keep such as have 4 10 hour days and then pass it off to an afternoon shift? Just not enough doctors?
+tkdyo By the end of residency, a doctor needs to be competent at diagnosing and managing a wide variety of common diseases. The thought is this would take a certain number of hours. For example, if you average 80 hours a week for 50 weeks a year for three years for an internal medicine residency, you need 12000 hours of training. If you want to lower the number of hours worked per week, you would then have to extend the number of years of medical training. The average amount of medical school debt is $200-300k. An average resident gets paid $50-60k. That's not enough to cover cost of living and the entire sum of the accumulating interest. Nobody would want their residency to be even longer than it already is.
+tkdyo Money, probably. There's plenty of unmatched MD's every year who don't have residency spots (myself included for many years now) who'd be willing to take open slots in residency programs.
+tkdyo 1) There is a lot to cover in medical school and residency 2) We are as a profession are rules followers 3) The tradition 50 plus years ago was to have "house officers" doctors in training who lived at the hospital and were on call all the time. Humanizing the process has been very slow, because many of us survived and learned a lot so it "might not be good to lighten up on these new kids".
Wouldn't electronic records help with the hand off problem? The Europeans seem to have embraced electronic records with no apparent problems, so why can't the US do the same?
+PersistentIllusion Australia has electronic records too. Nobody reads electronic handovers in full. Face to face handover is a vital part of the handover process.
+Wokanshutaiduo Snape Then there is a cultural problem that needs to be hammered into people: Always check the record! Always read the notes! Always document! Always notate! Every little thing you do needs to be there! The only reason one should have to _rely_ on face-to-face handovers are for things that just happened that couldn't be already documented, I would understand that face-to-face handovers are a good thing because they allow for questions to be asked and so on.
Yes an no. Obviously the records are vital! But the overnight staff cover hundreds of patients while the home team doctor covers 30. You can't expect the covering doctor to know who every patient on every team is let alone read every patients file when coming on to their shift. When called to see a patient yes they need to rely on paper/electronic records not the face-to-face handover. But the face-to-face one is important to flag the at-risk patients before the problems even arise; otherwise you're practicing reactive medicine only and not preventative.
+Wokanshutaiduo Snape I wouldn't expect the covering doctor to know or read every patient's file unless interacting with them. I also wouldn't expect much in the way of handover or even the opportunity for much with that difference in patient ratio. There should be a way for the patients at greater risk or more ongoing need of physical monitoring to be flagged and priorities in a hospital medical record system, which can then activiely alert physicians and nursing staff about who is at greater risk and may be in need of greater attention. Medical record systems, especially in hospitals, should not be passive things, but generating active alerts to staff to help insure necessary care is provided and fully documented. We certainly shouldn't expect a covering physician with potentially hundreds of patients to potentially care for to simply remember all that the multiple "home team" physicians said about patients, especially if there are emergencies or non-routine needs that arise. Systems that can help actively manage and remind covering physicians would be a better choice.
It sounds like residency is much more taxing than the regular shifts (which says a lot, considering how hard doctors work). Shouldn't residency accurately reflect what life will be like when you're working? That seems the most logical.
Residency down under is nowhere near as horrifying as your statistics. The longest shifts we've ever done are 14 hours, and they're not followed by on-calls. The average working week is 38 hours, up to 56 during certain parts of the surgical roster. We don't have morning shifts immediately following overnight shifts. Registrars and advanced trainees do work longer hours than us junior doctors depending on the specialty. But even my surgical registrar only worked 65 hour weeks on average. America, why is your system so f***ed?
Wokanshutaiduo Snape yeah that's true but what about the "hidden rule" of not being able to claim over time because the seniors will look down on you. plus getting treated like crap by them.
That mutual suffering creates a kind of brotherhood feeling, the same kind that people get after they complete hazing to get into a fraternity. Multiple social psychology studies suggest that this sort of mutual "rituals", or adversities increases the feeling of a unified in-group etc. So wouldn't this suffering to become a more noble and better doctor contribute positively on collegiality amongst physicians?
It's just some alpha male bullshit or alpha female it honestly doesn't matter it's just this thing of once you've endured all this grueling pain and rack up all this debt and get through it at least you've got something for it. But that's not a good mentality we need more doctors we need more people going through these fellowships and we need to realize that many people start into the profession because they care and may have very many family members of their own that inspired them to go into the profession. I hear so many that once they're done with medical school and fellowship that they State they would have never gone through it had they known. They're glad they had the experience and everything but they missed out on so much and we have such a high suicide rate. And so many of our hospitals and Medicine parts are run by and large profit and corporations they're seriously trying to fight for a reason to continuously be putting Patients health at risk an aggravating doctors for years on end. Stressing and putting them to their limit every now and then is a good test and a good exercise yes but consistently for years
That's horrific. It would only pay off for the very best paid specialties, and that is the case now; only very demanding specialties or very sub-specialized specialties have to undergo such a long training. The average U.S. medical student age is about 24 now, so add 4 years for medical school + 10 years for residency and then you get a 38 year old. They literally lived for half of their life in school. Not to mention, debt would be astronomical by that point. Residents get paid very little compared to their fully trained counterparts, so consider that. The average U.S. medical school debt is already about 200,000 USD, so add interest while trying to pay it back on a 30,000 to 90,000 USD salary depending on your rank, location, program, and specialty for 10 years (and remember, most of these students try to live off of their wages, too).
I can't help but think this episode completely missed the point. Like saying we shouldn't have wars because people get hurt. It's info is true but misses the point. If I remember correctly internship comes out of the US cavil war. As a kind of Dr Boot camp. That teaches the Dr what that are actually capable of instead of floundering in mediocrity. When a bus load of kids come in all torn up from an accident we don't want Dr saying "Well that's too much for me". You want them confident in there ability to handle the occasional overwhelming pressures.
+Lucid Moses Unfortunately, old-style residency (i.e. pre 2003) wasn't about the "occasional overwhelming pressures", but rather constant, unending overwhelming pressures for years on end. Can you imagine being recruited into an army which had a 5 year boot camp? That's what residency was like.
Eric Strong Yes, boot camp is longer then a day and a half. It wouldn't be effective if it wasn't long enough. 5 years does in fact seem beyond requirements but I don't think that's the average.
+Lucid Moses Not all doctors do the same thing. The majority of doctors out in the wild do not have a bus load of kids from an accident coming to them within their careers. The majority of doctors go into primary care. Why should residency programs be uniformly ridiculous when you don't need to be trained in those situations?
kennyc002 My hindsight is 20/20 too. trouble is predicting the future. Yet, besides the fact that your trying to dismiss the conceptual example and not think about the issue. Your saying you would like your primary care person to be floundering in mediocrity. Ok, But I bet most people would like there GP to be the best that they could be at what they do.
There's a difference in mediocrity and being equipped with tools you don't need. Sure I could learn how to program an ios program, and it might be useful somewhere, but it isn't a part of the skill set I need to be a good hardware engineer for Microsoft. Should all hardware engineers for Microsoft be required to learn how to program in ios? By the same criteria, should a GP be equipped with the ability to handle being a trauma surgeon when they are clearly not going to be in that situation? No, that's preposterous, and yet that's what is being proposed here. Second, I think you are having an unrealistic expectation of the field. The majority of people will revolve around the set standard given to physicians anyway. Since that set standard for practicing physicians do not contain your corner cases, it isn't a factor in physicians who are already practicing. I do think there should be a set standard for doctors to pass, but I do not think making the case hard/crazy to the point where suicide is the #1 killer for training doctors is compelling. I'd rather see a sensible standard and have my doctors alive than a fantasy land where docs are worked to this rate for 3 years then forget those "tools" within a few years time anyway.
90 FUCKING HOURS? Aren't there federal and state laws against this? That's way too much man, pretty sure Federal limit is 12 hours and then you need to rest so you have 8 hours break between shifts.
Katherine L. Vogel And that's the problem. There should be INSANELY strict limits on these at the city, state, and federal level to prevent EVERYONE from being over-worked, stressed, tired, etc. Sleep is INSANELY important and not near enough people, myself included, get the amount they should be getting. This has drastic health consequences.
I wasn't saying that the current standards for the industry are correct. However, I do think that there should be differences between industries... A secretary shouldn't have the same restrictions as a construction worker!
Katherine L. Vogel I disagree wholeheartedly. If we are all equal as people, then we should all have the same restrictions. That being said; I don't find it acceptable for a fast food service worker to work 15 hours anymore so than a doctor. I think it's terrible that people even THINK that people should be working that long. That's unethical and inhumane. People need rest. It is a very well known fact. Sleep is vastly important and frankly, I don't want tired or exhausted people working on me or for me. They will be more prone to mistakes and things. No one needs that, that's uneeded liability that can simply be resolved by ensuring your workers get proper rest and by this I mean at least give them the time to do it. There needs to be more efforts by companies in actually improving conditions for their workers, not just some bare minimum stuff. Workers should be comfortable and happy doing their job, this ensures maximum productivity.
Great video as usual but I feel that man of your videos tend to become loaded with statistics and data. I suppose you could make claims and add footnotes into the video description possibly? I think most of us would believe you for any claims you would make anyways...
Working over 80 hours a week in a physically, emotionally, and mentally demanding job may not make a difference in patient outcome, according to these studies, but I'm sure it has an effect on doctor's bedside manner which is an important part of patient care. It also can't have a good outcome for the resident's either. Asking an employee to work 80+ hours a week for a less than desirable pay is outrageous. Most residents have to start paying back their student loan debt while they are only making enough money to support themselves. Some residents also have families, or want to have one. They already spent all of their time during medical school studying and doing clinical rotations. After all of this stress on them and their personal relationships they are expected to spend all of their time at the hospital during their residency. There are 168 hours in a week. If the resident is working only 80 hours a week, that leaves them 88 hours for themselves. If you let them sleep for 8 hours a day, they are left with 32 hours of their own time for the entire week. Yet people still wonder why there is resident burn out... Some of the residents may want to work these insane hours, or feel obligated to because it is "part of the job". Just because doctors are held to a higher standard does not mean they aren't human. They need time to themselves to relax and take a break from such a stressful job, just like everyone else. Also, just like it was said in the video, some residents think it is noble to be completely miserable during their residency. They need to understand that this isn't how it should be. Further, how can a doctor or a surgeon recommend a healthy lifestyle to their patients when they aren't living one themselves? Although I want to be a surgeon, I don't believe that working all of these hours in a week will help. I see it like cramming for an exam. Cramming studying into a smaller time span doesn't help you learn and retain information. Spending most of the week in the hospital for residency probably doesn't help learning either. Exhausted residents probably don't retain as much information. However, if residencies were slightly longer in total length but less hours a week, I wonder if there would be a difference in resident burn out and retention of knowledge.
This is disgusting. No person should be asked to work this many hours. We need overtime laws to apply to every non-executive job. As a customer, I don't feel comfortable with the idea that my doctor could be that exhausted and as a human being, I feel like working someone like that is completely inappropriate.
Thanks Aaron for another insightful video. In discussions about residency work hours, almost everyone focuses on only patient safety and/or resident education. So when a study comes out that shows neither was impacted by changes in work hours or work schedule, people can use that to simply justify their original belief on the topic.
However, what almost no one talks about is what is ethically appropriate for an employer to ask of an employee. Employees in no other profession would tolerate what residents have traditionally been asked to tolerate: 80 hr work week, 28+ hr shifts, no guaranteed breaks of any kind, abuse from superiors, constant threat of retaliation for speaking up against unfair policies/practices, and on top of all that, minimum wage pay.
Using a study that showed no changes in patient safety or resident education as justification for readopting long resident work hours is like saying a study that shows child labor doesn't lead to increased child mortality rates means that child labor is perfectly ok.
Residents are hospital employees, and should be given all of the rights and safeguards as any other employee, including fair pay (which would literally be 2x what they typically currently receive).
+Strong Medicine Burn out rates for residents approach 100% by the end of their residency. That should be a clear sign as to what should be considered an issue. The problem is that it's expensive to train a resident, and paying them more isn't helping the issue. I'd rather see more residency spots opening up to train more doctors with the expanded cash going into the system if we are going to spend than paying the current residents more money. Granted I do have a bias in the matter, I'm an MD who will likely never receive the privilege to go into a residency, after all.
+Strong Medicine It is not measuring by child mortality it is measuring by product defects.
I love what you said in the second paragraph about the ethics of the topic, not just the physical barriers and impacts on care.
"However, what almost no one talks about is what is ethically appropriate for an employer to ask of an employee. Employees in no other profession would tolerate what residents have traditionally been asked to tolerate: 80 hr work week, 28+ hr shifts, no guaranteed breaks of any kind, abuse from superiors, constant threat of retaliation for speaking up against unfair policies/practices, and on top of all that, minimum wage pay. "
This speaks volumes, why would an employer want to have employees working shifts possibly up to 28 hours? There are many large studies out there showing that a person staying up more than the suggested hours performs much much worse than someone who is well rested. An individual that has been awake for that amount of time let alone working, needs to have stricter limits on hours able to work. This fatigue of the caregivers can ultimately lead to unhealthy caregivers and more common errors in patient care. There are things that we do not want to see in our care facilities. The video mentions low pay for residents, therefore not making the long terrible hours really worth the pain they have to suffer. Also the unfair treatment, abuse from superiors, etc. This is supposed to be a very special training and learning experience for the future doctors. We want the process to be difficult and strenuous so that only the best get into the programs, but we do not want it to effect the care that is administered to the patients. Neither do we want it to effect the learning process that the residents are going through.
I simply don't understand why someone would want to pursue a profession in which one must work 80+ hours a week just to become career ready; I really appreciate doctors but that seems cruel. If a person is exhausted all the time that can't possibly be good for patient outcomes.
As a patient (and I am an end-stage renal disease patient, so I'm not a filthy casual who gets a cold once in a while) the shifts required of doctors and nurses are straight-up horrifying to me. Medical professionals are supposed to be modeling and recommending healthy lifestyles to their patients, but how can they do that if it's just expected that they sacrifice their own mental health for three years during a residency? Even the experienced, tenured techs at my dialysis clinic are expected to come in at 10:00am one day and work a 13-hour shift, then come in a day later at 3:30AM. While it didn't come up in the studies you mentioned, I'd be curious to hear patient reactions if they were told the resident treating them in the ER had been on duty for 27 hours. The bottom line is that this system is totally broken and needs massive reform.
+stormbob ED physicians tend to work in shifts, so they don't have to be on call for 12+ hours at a time. That's actually one of the perks of going into emergency medicine. But the hours do they work, it's almost non-stop adrenaline rush.
I've done 30 hour calls with the trauma team before. Definitely some moments when I almost fell asleep in the OR, but it was otherwise nonstop experience. If you weren't up doing something, then you were sleeping in the call room.
+Dr.Smarty Pants I am sorry Dr. Smarty Pants, but I must disagree with you, more sleep is shown to result in far better performance and information retention.
You would likely be twice the doctor you are now if you had gotten the rest you needed during your residency, not half.
Working 100 hours a week is not good for you, going home and looking up cases is fine though.
Patient outcomes will not be improved unless we get residents down to 40 hours a week.
The residents' feelings that they will be worse doctors is due to indoctrination, and should be disregarded.
A longer residency with less hours would result in the same amount of practice without fatigue.
There are many kinds of fatigue that do not relate to lack of sleep.
Yeah, that is a good point. I still think that 80 hour work weeks is unhealthy though.
Saying that you personally know that working that hard is important is anecdotal and unreliable as it is difficult to correctly evaluate beliefs you are invested in from the first person.
We will be unable to verify your claims unless we actually have residents try lower hours before they have been convinced they need more.
I think many people would be willing to try that if presented with the actual hours residents are working. At this point we do not know if it would decrease or potentially increase positive patient outcomes.
I think the hour modifications we have already tried are not drastic enough to have made much of a difference.
Finally someone trying to address and at least talk about this issue that has been trivialized by medicine.
Being attached to and being identified by your work and doing these grueling calls only hurts the self esteem of residents and fellows. Feeling under appreciated for all they do further adds to the icing on top of this melting cake!
They start to underperform and take it as a chore, be less human, hardly engage in activities outside work, dissociate themselves from patients and come home from the most noble job with complete dissatisfaction.
Do yourself a favor and never associate your self identity to the residency or fellowship you’re in, it’s only the time to learn and grow. Make time to enjoy life like every other 9-5er until these people figure out the right hours for you!
The martyr complex that most doctors develop in undergrad is a major part of why I abandoned that career path. It's not healthy.
+photosinensis I'd like to hear an explanation of why that career and others must be unnecessarily difficult. If we produced more doctors, they could work normal work weeks.
+nonchalantd It's expensive to train, and most doctors do end up working a lot of hours to make ends meet with their debt with the falling insurance payments. The career path basically is in a death spiral.
+nonchalantd It's not about a scarcity of doctors. In fact, the situation these days is actually more like a whole bunch of med school students and graduates fighting for a limited number of positions/residencies.
James Sheppard Haha, as one of those people who can't get a residency, I can't help but feel happy that at least some people understand.
James Sheppard Do you think the limited residencies are by design in order to give doctors leverage during salary negotiations to maintain or raise them?
I thought medical school was hard. Now I'm more scared of residency.
+Evan Ales Residency is by far the worst.
+Evan Ales Naw, enjoy having a residency bro. I'm part of the 40 or so percent of IMGs that will never have that chance to make it into a residency. I can only look at you with envy.
+Evan Ales Medical school compared to college is like studying for finals almost every day. Residency is like studying for finals every waking hour 6 days a week for 3+ years.
kennyc002 What are you planning to do with your M.D.?
Spitzenhund Trying to focus on going into other aspects of medicine. In the meantime work odd jobs. There really isn't much you can do with an MD without a residency. Most of my colleagues who doesn't match have no idea what to do either. Lol
Another issue about long hours is that it may deter competent and intelligent people from pursuing a medical career. This could cause the whole industry to suffer if there is a lack of skilled workers. However, I think it would be very difficult to find data to back this claim up.
I find it rather at odds that people can argue that employing more nursing practitioners and "mid-level providers", who typically have fewer formal education hours than doctors, is adequate, but also can argue that residents need long hours in order to become good doctors.
My hospital just started its first class of family medicine residents. I'm excited to see how this goes.
Here in Australia we have graduated beyond the ancient and backwards thinking that non-stop gruelling hours is somehow 'noble' and displays' commitment' (although I still think surgical trainees have a little further to progress on that front). I'm an ED trainee and I'm rostered onto 80 hours per fortnight, although I do do overtime. Sure, we see less and our training programs are significantly longer, but we're also much better remunerated and work/life balance is far better. Who cares if you're not an 'attending/consultant' by the time you're 30, when you're earning good money, work flexible hours despite still being a registrar?
+Tasnadian Not to mention, with the undergraduate MBBS degree you can still get here, we CAN be consultants by the time we're 30 without wanting to kill ourselves before reaching that point.
True! Although many universities are starting to move towards the graduate 'MD'. I think it's just a marketing plot to lure North Americans desperate to get into med school (ie. Canada) and charging them like 60k a year for it..
I agree! The undergradate model actually works really well, and doesn't force you to cram two years of theoretical knowledge re: anatomy and physiology into one!
Wokanshutaiduo Snape anatomy isn't theoretical. If you check your pulse, you don't have a theory where the artery might be…you know where it is.
Seems like the experiment shows that no change results in no change. How about a real experiment comparing say 60 hour work weeks to 80 hour work weeks
Working over 80 hours a week in a physically, emotionally, and mentally demanding job may not make a difference in patient outcome, according to these studies, but I'm sure it has an effect on doctor's bedside manner which is an important part of patient care. It also can't have a good outcome for the resident's either. Asking an employee to work 80+ hours a week for a less than desirable pay is outrageous. Most residents have to start paying back their student loan debt while they are only making enough money to support themselves. Some residents also have families, or want to have one. They already spent all of their time during medical school studying and doing clinical rotations. After all of this stress on them and their personal relationships they are expected to spend all of their time at the hospital during their residency.
There are 168 hours in a week. If the resident is working only 80 hours a week, that leaves them 88 hours for themselves. If you let them sleep for 8 hours a day, they are left with 32 hours of their own time for the entire week. Yet people still wonder why there is resident burn out...
Some of the residents may want to work these insane hours, or feel obligated to because it is "part of the job". Just because doctors are held to a higher standard does not mean they aren't human. They need time to themselves to relax and take a break from such a stressful job, just like everyone else. Also, just like it was said in the video, some residents think it is noble to be completely miserable during their residency. They need to understand that this isn't how it should be.
Further, how can a doctor or a surgeon recommend a healthy lifestyle to their patients when they aren't living one themselves? Although I want to be a surgeon, I don't believe that working all of these hours in a week will help. I see it like cramming for an exam. Cramming studying into a smaller time span doesn't help you learn and retain information. Spending most of the week in the hospital for residency probably doesn't help learning either. Exhausted residents probably don't retain as much information. However, if residencies were slightly longer in total length but less hours a week, I wonder if there would be a difference in resident burn out and retention of knowledge.
I am a plastic surgery resident in Turkey now in my 18th month of training. As I began to the residency, I was working 30 days and 15 of them followed with night shifts (which is basically 36 hours x15 = 540 hours a month = 135 hours a week). As I grow older, such as now, I am working 30 days and 10-11 of them followed with night shifts. There is literally nothing noble about being "milked" by the system as there is a lack of surgeons who are trying to embrace the patients spoiled by the national healthcare system.
What is funny though, after the COVID pandemic, many European healthcare providers were complaining about how harsh the conditions became after the pandemic, but how much they were working as shifts were seemingly plausible for us and now we are kind of on a vacation :)
Particularly as mental health issues are stigmatised quite badly in the medical health field, well, over here in the UK at least from what I hear out of people I know in healthcare ^^"
Yes! My aunt is a surgeon and uses intimidation to get her way. She definitely thinks you have to suffer to commit to anything. I'm older now and want to become a Dr. but now I'm terrified lol
I know how mushy my brain is after work 10-12 hours.. why are our doctors held to such a higher max? I work 60 hr weeks on my feet dealing with people (retail, yay!) and that drains me and creates crappy work/life balance.. Why should doctors in charge of my care have to have it so much worse? Say 12 hour shifts... would only mean a patient would see 2 different doctors/day during a hospital visit. A more rested doctor can mean a clearer mind, more accurate patient records and thus, making patient care just as good (if not better?) during doctor changes...
Crazy....
Jlee S those are all presumptions
Check out what they are doing to Junior doctors over here in England.
NPR reported on this recently, and also seemed to take the study's perspective that these new residency regulations "didn't work" because evidently patient care and doctor education didn't improve. I was confused for the same reason -- didn't the study also prove that having residents work ungodly hours *doesn't* improve care or education? Are they really arguing that working those hours has no effect on these doctors' cognitive function and emotional regulation, as there's plenty of evidence sleeplessness and stress does, especially long-term? I wonder how many of these residents use stimulants to cope with this (e.g. Adderall, which could explain why their educational outcomes seemingly weren't affected).
Sounds like a case for a union or other form of organized labor power, to counteract this insane overwork.
In my opinion, the hours that residents and interns are expected to work are astonishing. This puts not only the patient in danger but the doctor as well. Doctors are supposed to exemplify healthy living and working 80+ hours a week and 28 hour day is not healthy whatsoever. The amount of sleep deprivation that doctors endure could lead to mistakes and the be harmful to the well-being of patients. If I were a surgical patient and I found out that my surgeon had been awake for more than 24 hours, I would not want them operating on me. I do not care what the statistics are working these hours is not healthy and potentially dangerous for the patients and the doctors. It has been proven that most doctors will more than likely suffer from mental health issues like depression which just adds to the stress of the job. Forcing doctors to take a day or two off will improve their personal well-being as well as the safety of the patients.
In mexico they make you work shifts of 36 hours not because of education but because residents are cheap work labor
Antonio Giron yes in some places (like mine) labor laws and minimum wage or maximum working hours dont count for some because interns amd residents are regarded as trainees and not employees.
I have the strong suspicion that that's the reason not only in Mexico.
I feel like it's the same elsewhere, because residents do get paid considerably less than fully trained doctors.
hahaha definitely the same here in Turkey. The national social healthcare system is there thanks to the residents, nothing else.
Can you do an episode on physician radiation exposure and cancer rates? I've always been curious if this was a risk factor for interventional cardiologists and radiologists.
I heard it used to be a big deal for interventional radiology, but now it's considerably better. They now have radiation exposure gauges to regulate and monitor radiation exposures. No doubt it's still a risk, but it's much better.
I'm in high school and am considering becoming a physician, but the prospect of 16+ hour work shifts in residency on top of the already strenuous medical school is rather frightening to me. Do people actually physically work the entire time they are in residency (all 16 hours), or is that just the "official" number? Maybe I should just go into engineering...
+Ahrk FinTey If you're interested in medical stuff but just don't think you could handle the demanding residency, consider looking into nursing, PA school, dentistry, pharmacy, etc. All are interesting medical fields that are still challenging in their own right but don't have the same kind of strenuous residency (though nursing hours can definitely be long, but not usually like this).
+Ahrk FinTey When I was in high school, I had no idea how being premed in college, applying to medical school, and what being a doctor was like. Now that I'm almost done with medical school, I would still tell my younger self to do it again.
However, you will meet a lot of doctors who will try to dissuade you from pursuing medicine. I think the best advice is to give yourself the chance to try out a few careers before settling on medicine. If you can find yourself loving any other career, do that instead. Being a physician requires too much physical, emotional, financial, and psychological sacrifice, but it is also extremely rewarding as well.
In short, study hard and keep an open mind. You still have a long way to go.
+Ahrk FinTey That's the "official" number. Residents can work longer hours than that...
Great video!
Brit here, is a resident roughly analogous to a junior doctor in the UK?
+CannonLongshot It's the same thing with a different name
+CannonLongshot Residents are people fresh out of medical school. In Australia we call first year residents as interns and everybody after the first year as residents.
US system is slightly more f*d up because they immediately go into surgical/medical in that first intern year, whereas we have a broader introduction to working years.
Wokanshutaiduo Snape Not fully true. For example, my friend is specializing in Interventional Radiology and he must first complete a year of broad internship before going into 4 years of residency. I think it depends on the specialty but most surgical specialties will involve a year of internship before residency.
Dr.Smarty Pants Yes its similar for us during the university years. During M1/2 its all theory based, plus the theoretical basis of Hx/Ex/Dx. Years M3/4/5 its all hospital based across varrious specialties, though not everyone does everything. The difference is that we still have undergrad models available so many of us go direct to M1/2 from high school, no premed degree beforehand.
But being a student and being a doctor are different experiences entirely. In intern year we do a medical term, a surgical term and an emergency term, plus another two of our choice. Only then as residents do we choose a surgical, medical or a general stream. Then gaining a fellowship can be anywhere from 3 years to 7 years minimum! (3 years for me as I'm going into general practice)
The conditions and hours that doctors must work is extremely dangerous for not only the patient they are attending to, but also the doctor themselves. In order to become a doctor, I have heard several stories of the stresses and lack of sleep medical school entails. Doctors wear this stress and sleeplessness as a badge of honor, like they are sacrificing themselves in order to save others. Are they really going to be capable of helping others if they can't even help themselves? It is extremely unhealthy for doctors to work shifts on no sleep, let alone 80+ hours a week. With this intense amount of work will come mistakes. If mistakes could be prevented just by taking some time off to sleep or even just some time for the doctor's themselves, I believe it is extremely beneficial. Despite what humans believe, doctors are humans too. The healthcare system is treating them in an inhumane manner and I believe it is wrong. Imagine if you were the patient and you realized your surgeon has been working a 24 hour shift. I would feel extremely uneasy fearing their sleep deprivation has the potential to influence their focus on my procedure. Mistakes are made when people are delirious. I liked how the video pointed out along with physical health problems, doctors will more than likely experience mental health issues, like depression. It would be extremely hard not to enter depression if one is worked ragged almost every day of the week. For the future, we should want our doctors to be excited about surgery, medicine, and helping patients recover. We don't want a doctor who is burned out and lacks a passion that they may have once had. Taking more time for themselves, I believe doctors and patients will both benefit.
Amazing
This entire situation is beyond absurd
I'm glad I didn't get into medical school. Being a toxicologist is way less miserable, pays about the same here, so it's all good.
The study is comparing 2 utterly ridiculous circumstances and trying to see if one is better than the other. NEITHER is good. Seriously, cap the hours at something normal people can function under. 60 hours a week should be the cap. 15 hours A DAY should be a maximum.
We need to rethink the entire medical school/training process. 4 years of undergrad and then medical school is time wasting. If we made it one step - Make the pre-med stuff part of the Medical curriculum and we could have longer less grueling residencies.
+am2schmarvelous I don't know... from my experience in a health-related field, I'm amazed medical school is even enough to cover the entire field sufficiently in a way that can be retained. Every year we add more and more knowledge to our understanding of human physiology and pathology... and that's one more often very complex thing medical students must learn.
If anything, putting more more stuff in pre-med undergrad might help. If you're majoring in pre-med, maybe streamline the general education so you can start getting a lot more advanced sooner, e.g. one year of gen ed, 3 years of increasingly advanced biology, chemistry, molecular, etc.
+mar9en It works for us down in Australia. My med degree started immediately after high school and was 5 years long. Am a PGY2 resident now, and our weeks are typically 40 weeks. American residencies are insane.
Do you do this full time or do you still practice medicine?
+Joey's third chin He is, part-time. He's a university professor, practicing pediatrician, health care researcher, and RUclips star!
+Greg McLean wow that's amazing!! Do you know why school he teaches at?
Indiana University. He's got a bunch of bios online, Google "Aaron Carroll"
+Greg McLean And he co-writes books!
I wouldn't trust myself stacking shelves at the end of an 80 hour week, nor at the end of a 12 hour day, and yet Aaron seems to be comparing the practice of working 12 hour days with LONGER hours... Would it not be useful and meaningful to look at the patient and physician outcomes for shorter working hours?
Oisin Creaner how short are you suggesting?
A hard cutoff limit less than 12 hrs would feel nearly like a half-day.
In our country, our interns and residents work 100 plus hours a week in tertiary and public hospitals. When I did training in one of the maternity hospitals, we had 10 residents and 10 medical students in 24 hours delivering between 60 to 80 patients.
It's definitely not healthy but major mistakes are rare because of proper supervision.
Sorry to say this, but western and especially American doctors are very spoiled. There are actual studies that IMGs or International Medical Graduates make less errors.
I do not think think residents should be working more than a 12 hours shift, even
if they have to explain the whole thing all over again to another resident or
doctor. if you are saying that they might be in the middle of a surgery when
why would they start it to begin with. I would not comfortable, mentally and
humanly knowing my doctor is perhaps exhausted. and I am not a person who just
stops by a hospital when they get a cold or a sore throat, I think people
nowadays should be able to recognize or diagnose themselves with those. Plus,
another argument is that it would affect the doctor's or resident's mood or
mentality which will affect their reputation badly, even if they did diagnose
their patients wrongly, a patient is more likely to forgive a doctor if were
nice or treated the patient well. as I said, long hours will affect their moods
which will affect their performance which affects their reputation."
KinKinOmar 1) remember, there are no work hour restrictions after residency.
2) surgery duration is estimated but never guaranteed; if unexpected findings arise and add 4 hrs to the surgery, closing up & ending the surgery because it would extend past a theoretical shift limit isn't even a consideration in the decision-making process.
There needs to be a cap on all job shifts. 13 hours and then YOU GO HOME, PERIOD and then you can not work that long again for like 2 days.
Health and Sanity are far more important and I'm not just talking about doctors here.
+Scheefinator For ongoing schedules, I'd say that sounds like a good policy, but there are some situations where it wouldn't work. When it comes to something like disaster response, you might need all hands on deck for 112 hours a week, but you're only doing that for like two weeks.
John Harvey
Nope, hire more people to compensate for those times.
I do not think it is acceptable for any individual to work over 14 hours days, period for any reason.
And I think that asking someone to do so is unethical, especially when you can hire more people to compensate.
Scheefinator
> Nope, hire more people to compensate for those times.
-- It doesn't work that way. Personnel and funding are finite, and there are logistical, operational, and training-related reasons why you can't just "hire more people".
> And I think that asking someone to do so is unethical, especially when you can hire more people to compensate.
-- ... and when you can't? When you've hired all the people you could get and it's been 14 hours but there are still people buried under rubble, do you yabba-dabba-doo your way back to your tent or do you keep digging?
John Harvey
Stop sliding this into extreme territories like that.
I told you, all of your reasons besides ones of ACTUAL emergency are the results of greedy corporate profit and the unwillingness to spend money.
I don't want to hear such excuses, don't fall for this shit, they can always hire more people, they just won't.
Can't cut into those precious 100k plus executive checks in order to make work conditions better for people, folks. Nope, wouldn't want to do that.
I told you my stance. It will not change.
Scheefinator
>Stop sliding this into extreme territories like that.
-- I'm picking "extreme territories" because you're trying to apply an absolute rule to all cases (which is rather extreme, don't you think?), and a rule that doesn't account for edge cases is a bad rule. Thirteen hours is not extreme. I'm not even talking about people working for three or four days straight without sleep in the case of something like 9/11. I'm talking about stuff that happens all the time.
>I told you, all of your reasons besides ones of ACTUAL emergency are the results of greedy corporate profit and the unwillingness to spend money.
-- You act as though emergencies are rare, but they happen pretty regularly and need to be accounted for. Emergency preparedness is built into every part of a functioning society (your workplace has a fire extinguisher, right?), so a rule that tries to rule over the entire workforce had better account for it as well.
>I don't want to hear such excuses, don't fall for this shit, they can always hire more people, they just won't.
-- Hire more people, you say? Why didn't I think of that? Could it be that things aren't that simple in the real world? We do not live in a post-scarcity economy, so the labor pool is finite, infrastructure is finite, and funding is finite, so when you have a small number of workers suddenly facing a fuck-ton of work... well, somebody's going to have to actually work for a living. Mobilizing personnel takes a lot of coordination, a lot of time, and a lot of money. Workers can't be conjured from the aether, so "just hire more people" is not a solution. Each of them has to be trained, tested, certified, equipped, kept track of, and in the cases I'm referring to they also need to be dispatched, boarded, fed, transported... and you're talking about multiplying that. There were more than seven thousand people on the 2014 King Fire (not a record, by the way), and they all needed a place to pitch their tent, food to eat, and somewhere to shit, so I don't know where you'd propose to put the extra couple of thousand you'd need with your proposed candy-ass schedule or whose money you propose to spend.
The divorce anecdote was showing a bit of dark humor. The idea that sacrificing your personal life and making yourself miserable has been enforced in many people from: students, veterinarians, teachers ect., as it commonly seen that the person is sacrificing their own happiness for those of others.
Veterinarians do the exact same thing as GPs... and they get paid less. -.-
Why did it even become a thing for doctors and nurses to have ridiculous shifts? Why cant they just employ the same methods as other industries that require 24 hr up keep such as have 4 10 hour days and then pass it off to an afternoon shift? Just not enough doctors?
+tkdyo By the end of residency, a doctor needs to be competent at diagnosing and managing a wide variety of common diseases. The thought is this would take a certain number of hours. For example, if you average 80 hours a week for 50 weeks a year for three years for an internal medicine residency, you need 12000 hours of training. If you want to lower the number of hours worked per week, you would then have to extend the number of years of medical training.
The average amount of medical school debt is $200-300k. An average resident gets paid $50-60k. That's not enough to cover cost of living and the entire sum of the accumulating interest. Nobody would want their residency to be even longer than it already is.
+tkdyo Money, probably. There's plenty of unmatched MD's every year who don't have residency spots (myself included for many years now) who'd be willing to take open slots in residency programs.
+tkdyo 1) There is a lot to cover in medical school and residency
2) We are as a profession are rules followers
3) The tradition 50 plus years ago was to have "house officers" doctors in training who lived at the hospital and were on call all the time. Humanizing the process has been very slow, because many of us survived and learned a lot so it "might not be good to lighten up on these new kids".
Wouldn't electronic records help with the hand off problem? The Europeans seem to have embraced electronic records with no apparent problems, so why can't the US do the same?
+PersistentIllusion Australia has electronic records too. Nobody reads electronic handovers in full. Face to face handover is a vital part of the handover process.
+Wokanshutaiduo Snape Then there is a cultural problem that needs to be hammered into people: Always check the record! Always read the notes! Always document! Always notate! Every little thing you do needs to be there!
The only reason one should have to _rely_ on face-to-face handovers are for things that just happened that couldn't be already documented, I would understand that face-to-face handovers are a good thing because they allow for questions to be asked and so on.
Yes an no. Obviously the records are vital! But the overnight staff cover hundreds of patients while the home team doctor covers 30. You can't expect the covering doctor to know who every patient on every team is let alone read every patients file when coming on to their shift. When called to see a patient yes they need to rely on paper/electronic records not the face-to-face handover. But the face-to-face one is important to flag the at-risk patients before the problems even arise; otherwise you're practicing reactive medicine only and not preventative.
+Wokanshutaiduo Snape I wouldn't expect the covering doctor to know or read every patient's file unless interacting with them. I also wouldn't expect much in the way of handover or even the opportunity for much with that difference in patient ratio. There should be a way for the patients at greater risk or more ongoing need of physical monitoring to be flagged and priorities in a hospital medical record system, which can then activiely alert physicians and nursing staff about who is at greater risk and may be in need of greater attention. Medical record systems, especially in hospitals, should not be passive things, but generating active alerts to staff to help insure necessary care is provided and fully documented. We certainly shouldn't expect a covering physician with potentially hundreds of patients to potentially care for to simply remember all that the multiple "home team" physicians said about patients, especially if there are emergencies or non-routine needs that arise. Systems that can help actively manage and remind covering physicians would be a better choice.
PersistentIllusion electronic records are risky as well. Nowadays some people will hack and hold all of a hospital's records for ransom for millions.
It sounds like residency is much more taxing than the regular shifts (which says a lot, considering how hard doctors work). Shouldn't residency accurately reflect what life will be like when you're working? That seems the most logical.
Chelsea Bee Books it can be the exact opposite. Remember, there is no work hr rule following residency training.
Residency down under is nowhere near as horrifying as your statistics. The longest shifts we've ever done are 14 hours, and they're not followed by on-calls. The average working week is 38 hours, up to 56 during certain parts of the surgical roster. We don't have morning shifts immediately following overnight shifts.
Registrars and advanced trainees do work longer hours than us junior doctors depending on the specialty. But even my surgical registrar only worked 65 hour weeks on average.
America, why is your system so f***ed?
Wokanshutaiduo Snape yeah that's true but what about the "hidden rule" of not being able to claim over time because the seniors will look down on you. plus getting treated like crap by them.
That mutual suffering creates a kind of brotherhood feeling, the same kind that people get after they complete hazing to get into a fraternity. Multiple social psychology studies suggest that this sort of mutual "rituals", or adversities increases the feeling of a unified in-group etc. So wouldn't this suffering to become a more noble and better doctor contribute positively on collegiality amongst physicians?
instead of spending money on war , people should invest in paying hospitals to pay residents more!
It's just some alpha male bullshit or alpha female it honestly doesn't matter it's just this thing of once you've endured all this grueling pain and rack up all this debt and get through it at least you've got something for it. But that's not a good mentality we need more doctors we need more people going through these fellowships and we need to realize that many people start into the profession because they care and may have very many family members of their own that inspired them to go into the profession. I hear so many that once they're done with medical school and fellowship that they State they would have never gone through it had they known. They're glad they had the experience and everything but they missed out on so much and we have such a high suicide rate. And so many of our hospitals and Medicine parts are run by and large profit and corporations they're seriously trying to fight for a reason to continuously be putting Patients health at risk an aggravating doctors for years on end. Stressing and putting them to their limit every now and then is a good test and a good exercise yes but consistently for years
Make residency 10 years instead of 5 years and they work regular 40 hr weeks with call. 4 or 5 years is not long for residency anyway.
That's horrific. It would only pay off for the very best paid specialties, and that is the case now; only very demanding specialties or very sub-specialized specialties have to undergo such a long training. The average U.S. medical student age is about 24 now, so add 4 years for medical school + 10 years for residency and then you get a 38 year old. They literally lived for half of their life in school. Not to mention, debt would be astronomical by that point. Residents get paid very little compared to their fully trained counterparts, so consider that. The average U.S. medical school debt is already about 200,000 USD, so add interest while trying to pay it back on a 30,000 to 90,000 USD salary depending on your rank, location, program, and specialty for 10 years (and remember, most of these students try to live off of their wages, too).
I can't help but think this episode completely missed the point. Like saying we shouldn't have wars because people get hurt. It's info is true but misses the point.
If I remember correctly internship comes out of the US cavil war. As a kind of Dr Boot camp. That teaches the Dr what that are actually capable of instead of floundering in mediocrity.
When a bus load of kids come in all torn up from an accident we don't want Dr saying "Well that's too much for me". You want them confident in there ability to handle the occasional overwhelming pressures.
+Lucid Moses Unfortunately, old-style residency (i.e. pre 2003) wasn't about the "occasional overwhelming pressures", but rather constant, unending overwhelming pressures for years on end. Can you imagine being recruited into an army which had a 5 year boot camp? That's what residency was like.
Eric Strong Yes, boot camp is longer then a day and a half. It wouldn't be effective if it wasn't long enough. 5 years does in fact seem beyond requirements but I don't think that's the average.
+Lucid Moses Not all doctors do the same thing. The majority of doctors out in the wild do not have a bus load of kids from an accident coming to them within their careers. The majority of doctors go into primary care. Why should residency programs be uniformly ridiculous when you don't need to be trained in those situations?
kennyc002 My hindsight is 20/20 too. trouble is predicting the future.
Yet, besides the fact that your trying to dismiss the conceptual example and not think about the issue. Your saying you would like your primary care person to be floundering in mediocrity. Ok, But I bet most people would like there GP to be the best that they could be at what they do.
There's a difference in mediocrity and being equipped with tools you don't need. Sure I could learn how to program an ios program, and it might be useful somewhere, but it isn't a part of the skill set I need to be a good hardware engineer for Microsoft. Should all hardware engineers for Microsoft be required to learn how to program in ios? By the same criteria, should a GP be equipped with the ability to handle being a trauma surgeon when they are clearly not going to be in that situation? No, that's preposterous, and yet that's what is being proposed here.
Second, I think you are having an unrealistic expectation of the field. The majority of people will revolve around the set standard given to physicians anyway. Since that set standard for practicing physicians do not contain your corner cases, it isn't a factor in physicians who are already practicing. I do think there should be a set standard for doctors to pass, but I do not think making the case hard/crazy to the point where suicide is the #1 killer for training doctors is compelling. I'd rather see a sensible standard and have my doctors alive than a fantasy land where docs are worked to this rate for 3 years then forget those "tools" within a few years time anyway.
90 FUCKING HOURS? Aren't there federal and state laws against this? That's way too much man, pretty sure Federal limit is 12 hours and then you need to rest so you have 8 hours break between shifts.
+Scheefinator Hourly limits and mandated breaks are dependent on industry.
Katherine L. Vogel
And that's the problem. There should be INSANELY strict limits on these at the city, state, and federal level to prevent EVERYONE from being over-worked, stressed, tired, etc.
Sleep is INSANELY important and not near enough people, myself included, get the amount they should be getting.
This has drastic health consequences.
I wasn't saying that the current standards for the industry are correct.
However, I do think that there should be differences between industries... A secretary shouldn't have the same restrictions as a construction worker!
Katherine L. Vogel
I disagree wholeheartedly. If we are all equal as people, then we should all have the same restrictions.
That being said;
I don't find it acceptable for a fast food service worker to work 15 hours anymore so than a doctor. I think it's terrible that people even THINK that people should be working that long.
That's unethical and inhumane. People need rest. It is a very well known fact.
Sleep is vastly important and frankly, I don't want tired or exhausted people working on me or for me. They will be more prone to mistakes and things.
No one needs that, that's uneeded liability that can simply be resolved by ensuring your workers get proper rest and by this I mean at least give them the time to do it.
There needs to be more efforts by companies in actually improving conditions for their workers, not just some bare minimum stuff. Workers should be comfortable and happy doing their job, this ensures maximum productivity.
Dr.Smarty Pants
No more than 14 hours a day, period. Hire more people to compensate.
That's my stance and it will not change.
Great video as usual but I feel that man of your videos tend to become loaded with statistics and data. I suppose you could make claims and add footnotes into the video description possibly? I think most of us would believe you for any claims you would make anyways...
Working over 80 hours a week in a physically, emotionally, and mentally demanding job may not make a difference in patient outcome, according to these studies, but I'm sure it has an effect on doctor's bedside manner which is an important part of patient care. It also can't have a good outcome for the resident's either. Asking an employee to work 80+ hours a week for a less than desirable pay is outrageous. Most residents have to start paying back their student loan debt while they are only making enough money to support themselves. Some residents also have families, or want to have one. They already spent all of their time during medical school studying and doing clinical rotations. After all of this stress on them and their personal relationships they are expected to spend all of their time at the hospital during their residency.
There are 168 hours in a week. If the resident is working only 80 hours a week, that leaves them 88 hours for themselves. If you let them sleep for 8 hours a day, they are left with 32 hours of their own time for the entire week. Yet people still wonder why there is resident burn out...
Some of the residents may want to work these insane hours, or feel obligated to because it is "part of the job". Just because doctors are held to a higher standard does not mean they aren't human. They need time to themselves to relax and take a break from such a stressful job, just like everyone else. Also, just like it was said in the video, some residents think it is noble to be completely miserable during their residency. They need to understand that this isn't how it should be.
Further, how can a doctor or a surgeon recommend a healthy lifestyle to their patients when they aren't living one themselves? Although I want to be a surgeon, I don't believe that working all of these hours in a week will help. I see it like cramming for an exam. Cramming studying into a smaller time span doesn't help you learn and retain information. Spending most of the week in the hospital for residency probably doesn't help learning either. Exhausted residents probably don't retain as much information. However, if residencies were slightly longer in total length but less hours a week, I wonder if there would be a difference in resident burn out and retention of knowledge.