10 ms·

You were dealing with doctors and nurses, right? One group runs a gauntlet of fire by sleep deprivation during pre-med training: with on-call work hours up to

You were dealing with doctors and nurses, right? One group runs a gauntlet of fire by sleep deprivation during pre-med training: with on-call work hours up to 120 hours a week. And the other group are typically on shift rotas so their sleep patterns are permanently disrupted. I'm going to call it for them being oblivious to the sleep requirements of ordinary human beings, because these professions are self-selecting for sleep-dep survival traits; only people who can work insane hours make it through hospital medical training, and only people who can take shift work in their stride make it as hospital nurses. (Also, my observation of hospital doctors is that anyone you see on a ward outside core office hours is relatively junior, i.e. aged about 22-35. Senior consultants and professors work normal hours like everybody else. As for the nurses ... my understanding is that ICU nursing burns them up.) (Source of observations: former hospital pharmacist here, who just got a refresher course c/o a relative who spent three months on an acute stroke ward this fall.)

technofiend 8y ago
>One group runs a gauntlet of fire by sleep deprivation during pre-med training: with on-call work hours up to 120 hours a week. I would argue this is the source of injury and death to the patients that needs to be addressed rather than powered through in some sort of macho hazing ritual. Anecdotally a very tired doctor is allegedly how my wife lost her mother.
- mfe5003 8y ago
  I've always assumed that the failure rate for handing off care to another person and the rate because of long hours must go in favor of long hours. I don't have anything to back this up except the MCAT being designed to check how you perform when tired. Now with electronic records I've been wondering if long hours are still be necessary, assuming I'm right about the failure rates. I'm sorry about your mother in law regardless.
  - mattkrause 8y ago
    This is the claim, but if you look at the experiments supporting it, they’re all bonkers. For example, care is no worse from doctors on 28 hr shifts vs 24. I would argue that both of these are so far from a well-rested baseline that they’re meaningless. We know from lab experiments that performance craters way, way before that, which is why pilots, truck drivers, cops, and every other profession work shorter shifts.
    - jchanimal 8y ago
      All this talk is insane. I have like maybe 4 top-performing hours on my best days. The idea of working more than 8 in a life safety critical situation boggles the mind.
  - verelo 8y ago
    Super intersting to see people discussing this! As someone that holds a pilots license and talks with a lot of commercial pilots about their jobs, sleep is often a hot topic of discussion. It would be illegal, not just irresponsible, for a pilot to try pull off a 120 hour work week. Why do we treat doctors differently? Their macho behaviour in my opinion is unacceptable, and likely reduces positive patient outcomes, yet it goes on?
    - GavinMcG 8y ago
      Medicine has different concerns than piloting, though. Pilots don't have to ensure continuity of care for their passengers, and can accomplish their work in reasonable chunks. Doubling the number of patient handoffs, on the other hand, significantly increases the risk of one of the more common sources of error.
      - km3k 8y ago
        But could the increase in errors from increased hand-offs be smaller than the increase in errors from sleep-deprived doctors, nurses and patients combined with the increase in disease spread and disease progression from the effect of sleep deprivation on the immune systems of doctors, nurses and patients? Additionally, could there be benefits from getting more eyes on a patient's condition?
      - foobarchu 8y ago
        I've always wondered if the problem might be in the handoff procedures. Those studies about mortality in the event of a handoff always make it sound like obviously handoffs are an inherently dangerous thing, but perhaps the modern way of doing them is just poorly implemented? It feels extremely unlikely to me that absurdly long hours are the only solution.
        verelo 8y ago
        I think this is a rational question to ask! Often people will jump to conclusions "handoffs cause errors", and while errors are a symptom of handoffs executed poorly, it seems uncommon for people to often ask for improvements to these processes.
- Nasrudith 8y ago
  Medicine is a conservative field - unfortunately that also includes ignoring anything harmful to their cult aspects even if it is trivially obvious like "wash your hands" after doing a damn autopsy before delivering a baby. Or yes infants can feel pain - not using anesthesia because the control isn't fine enough to not have a better chance of killing them is a grim but justifiable thing initially but inexcusable once it becomes possible to do so safely. And the sleep deprivation and hazing "I did it so everbody else must too!" is definitely a cultic thing. I use cult very deliberately to point at the reasoning being entirely irrational and social as opposed to underlying value. And also because actual cults use slerp deprivation.
- IB885588 8y ago
  Peter Attia (MD) had a podcast episode where he talked about being a resident and how it almost killed him (asleep while driving) and was bad for patient. Also explained that the guy who created the residency program was a cocaine addict who rarely slept, and since then all doctors have to try to follow his crazy schedule for no good reason..
  - ineedasername 8y ago
    Yeah. I mean, I get that hospitals are 24-hour operations that need doctors & nurses available at all times. So some people are going to get the crap end of that stick and have to do night shifts. But is it really necessary for them to work 80+ hours while they're at it? It seems like there's enough people trying to be doctors that you could cut that down to a healthier 40 hours+ 15 hours on call if it's really necessary to. Heck, even 50 hours.
    - pc86 8y ago
      You would likely have to extend residency based on everything that you need to learn for a given specialty. Med school graduates have an average of over $180k in student loan debt - from med school alone - and resident salaries in the 2-4 year programs are mid five figures. Given the choice, I'm not sure someone whose 4-year earning potential is capped at $60k with $200k in student loans would want to extend that to 5/6/7 years.
      - antidesitter 8y ago
        I believe the GP is talking about increasing the number of doctors, not their years in residency.
        pc86 8y ago
        You learn how to do your entire specialty during residency. If you cut the number of hours, you have the same amount to learn in less time.
- da_chicken 8y ago
  I used to work in hospital IT at a level 1 trauma center from 2004-2006. While I was there, an article was released which studied the relationship between time on shift and errors made by staff. As I recall (and it has been 10 years) the findings were: * Through roughly 9 hours, the error rate was about the same. Say, x% * In the 10th hour, the error rate increased. Say x + y%. * In hours 11 and 12, the amount the error rate increase doubled the 10th hour's increase. So x + 2y%. * In hours 13 and 14, the amount the error rate increase quadrupled the 10th hour's increase. So x + 4y%. * In every subsequent hour studied, the error rate increase doubled again. x + 8y% in hour 15, x + 16y% in hour 16. I want to say the study went to 18 hours, but I don't recall if it was 16 or 18 at this point. The paper made the recommendation that shift lengths should be limited to 10 hours maximum. Every health care professional I spoke to about the article (resident doctors and nurses, maybe 10 overall, mostly in the ER) said the same three things: 1. They had personally witnessed someone make an error they could attribute to tiredness. 2. They themselves had never made a mistake due to tiredness. 3. They didn't want to change their schedule. Either they liked having 4 days off every week, or they thought it wasn't a significant problem.
  - technofiend 8y ago
    2. They themselves had never made a mistake due to tiredness. 3. They didn't want to change their schedule. Either they liked having 4 days off every week, or they thought it wasn't a significant problem. I think those two items and the tribal knowledge that handoffs are more dangerous to the patient helps the overwork model persist. Sounds like it's past time the medical industry prove that handoffs are more dangerous to patient outcomes. Doctors are trained to be problem owners and problem solvers, but that doesn't make them good team players. And lowering handoffs also limits oversight and prevents second guessing which is great if you're convinced you're always right, but clearly doctors are not always right and patients often pay the price.
- brahmwg 8y ago
  There's been some study(s) which suggest that medical error is the 3rd leading cause of death. This may have been debunked so if wrong please correct me. https://www.cnbc.com/2018/02/22/medical-errors-third-leading-cause-of-death-in-america.html https://www.cnbc.com/2018/02/22/medical-errors-third-leading...
- SkyPuncher 8y ago
  Many sane minds would argue that, but the ACGME is actively arguing otherwise. They are actively building rules that allow residents to work longer shifts (up to 28 hours straight) while claiming these rules improve patient safety. Patient hand-offs between shifts tends to introduce errors. Instead of finding ways to improve hand-offs, the ACGME is simply trying to have fewer of them. These are supposed to be some of the "top minds" in medicine and that's the best they can come up with.
  - technofiend 8y ago
    That's no really addressing the problem, it's just doubling down on the mistaken notion that the treating physician is the best one to tend to the patient under any circumstance. Doctors need to learn to be team players.
spdustin 8y ago
Nurses are a lot more than just shift change workers, and their nursing school requirements are a lot higher than you seem to believe.
- yial 8y ago
  I don’t think (s)he was commenting on education. I read their comment as only people who can do 12 hour shifts that may be required to occasionally be overnights followed by days, completely disrupting their sleep schedule, can make it as ICU nurses.
- Piskvorrr 8y ago
  "Works on a shift schedule" is a shared trait between nurses and shift workers. "Has one thing in common with" is not the same as "is the same thing as".
- spdustin 8y ago
  Parent to that reply edited their post after my comment, and I can no longer edit my reply.
DisruptiveDave 8y ago
To be clear, you're saying that people whose job is to - quite literally - understand, diagnose, and treat hundreds (thousands?) of medical issues that they personally haven't experienced, don't have the capacity to understand that not everyone is on their same sleep schedule?
- km3k 8y ago
  Yes.
- jyounker 8y ago
  Doctor's are notorious for not understanding their patients' experiences, and how that impacts them. I've just witnessed this with my partner's recent bout with cancer. While her oncological surgeon completely understands, her reconstructive surgeon had no conception of what she was going through.
- LeifCarrotson 8y ago
  Those people spent many years learning to understand, diagnose, and treat thousands of medical issues. During that entire time, they were continuously sleep deprived as a matter of culture. Those that could not handle this environment dropped out. They're probably still sleep deprived. They may have learned about sleep's medical effects, but the personal experience of those who survived the selection process who work 120-hour weeks and have been waking patients up once an hour for years has a blinding effect on this diagnosis. It's a bit like bringing someone from south Florida to northern Michigan this winter for some ice fishing. I understand that it's cold here, I intellectually know about, have observed the effects of, and can treat frostbite and other problems resulting from this cold - but all that would make it hard for me to intuit the problems of a visitor who was unable to control their fingers when they removed their gloves and dipped their hands into a minnow bucket to bait a hook. My fingers work fine in that bucket, everyone else on the lake is doing it, you're just going to dry them off in a few seconds and put them back in warm gloves...what's the issue?
  - deleted 8y ago
    [deleted]
kerbalspacepro 8y ago
Why do doctors not get sleep? It is still the most ridiculous thing I've ever heard. Start up founders? Fine. Grocery store bagger? I don't care. BUT A PERSON IN CHARGE OF TOUCHING (inside) MY BODY? I want their Fitbit sleep records for the last month showing a consistent 7 hours of sleep.
- stevehawk 8y ago
  Regarding the U.S., the reality is that it's mostly the students (med students, residents and fellows.. you're called Doctor by residency) that are sleep deprived. After that most doctors are on normal to normal-ish cycles. But because residents and fellows are such solid profit earners for hospitals and the hospital owns their life they opt to over-work them and charge you max dollar for their time. Once the doctor is board certified (post residency or fellowship) then the power shifts back towards the doctor and they can get more normal lives. Exceptions are specializations that are essentially emergency/urgent but even most of them are on rotations like another poster mentioned where they've shifted their own sleep patterns to match their hours. Since watching my friends become doctors (psychiatrists, uroligists, neurointerventional readiology) and my wife become a surgeon I have started telling friends and family "If your doctor looks under the age of 35 then you should ask them the last time they slept before they start treating you. tl;dr : hospitals straight up own the futures of their med students/residents/fellows .. so they overwork them while paying them $40-55k year, and when they aren't working they have to study for their exams.
- billfruit 8y ago
  Also apart from the Doctors, the military is also notorious for their practice of having too little sleep.
  - jartelt 8y ago
    Yes! Sleep deprivation played a role in the two Navy crashes in the last few years.
  - topkai22 8y ago
    This is because their job absolutely requires performing on insufficient sleep. Combat isn't shift work. I think (without much data here) that medical training pushes insufficient sleep on doctors due to on-call schedules. While hospitals have doctors, many of their specialists come from private practice or multi-specialty clinics, which rotate being on-call between then (often in 12 hour shifts). The other cause of insufficient sleep is that if a patient under care of doctor has complications, they will often be called, even if just for a consult. Economically, this is likely efficient compared to having hospital specialists (which may end up with nothing to do many nights), but causes docs to train for worst case scenarios sleep-wise.
gerbilly 8y ago
> during pre-med training: with on-call work hours up to 120 hours a week. Can someone please tell me why they still put medical students through this institutional hazing?
- pc86 8y ago
  Saying that "pre-med training" (whatever that means) consists of 120 hour work weeks is not accurate but it's probably just because we're using the wrong words. Pre-med = college, and aside from the highly scientific work load is no different than any other college experience. Medical school (no longer called "pre-med" by anyone) is typically 2 years of classes and 2 years of clinical rotations. The rotations are not going to be 120 hours a week but may be 60-80. But unless you go to a teaching hospital and consent to student contact (which may or may not be a requirement of treatment) no med school student is touching you. Residency is after med school (they're full doctors now) where you train your specialty, and at least in the 4 year program I'm familiar with, their title is intern, resident, resident, senior resident for each of the four years. They have increasingly high levels of responsibility as they progress and by the 4th year they are basically oversight/management of the other residents who assist on complex cases and bring in at attending physician(s) for big stuff. Hours are typically 80+ and I'm sure you could approach 100 for very demanding or emergent specialties but it's certainly not "pre-med training" and 120 is pushing it for sure. After you graduate residency you move to an attending, fellowship, or research position and the hours drop back down to the 60-70 range and decrease as you gain seniority.
  - jyounker 8y ago
    And on top of those 60-80 hours per week you need to add all the time prepping for exams and boards, correct? That study time is work too, and that pushing up to 120 hours per week.
- jac241 8y ago
  In medical school, 120 hour weeks really only exist for 4th year med students who are on sub-internships in surgical specialties like neurosurgery, orthopedic surgery, general surgery, etc. Students in those fields do 3 or so month long sub-i's at hospitals they want to do residency at. They basically function as month long interviews for those programs, and are also used to get letters of recommendation from prominent faculty in the field. People who are interested in those fields know about the hour requirements on sub-i's and in residency, and self-select in a way. The reason resident physicians work so much is because residents make $60k working 80+ hour weeks, and the PAs or NPs who would be willing to cover the floors at night would make $150k+ working 40hrs/wk. Residents also have no collective bargaining power because of the residency match system. You can't easily leave one program and go to another because you don't like the working conditions, for example. If you want to leave, you're more or less blackballed unless you're switching fields. And you don't want to speak up about the conditions because you've got $300k in debt and a degree that's useless until you finish residency.
cowpewter 8y ago
My mom was an ICU nurse for over 20 years, and yeah, the burnout is real. My mom always said that ICU is made up of a very small number of surgery recovery patients (who quickly get moved to a different section once they're past the critical part of their recovery), and the rest is people who are just there to die (especially here in Florida, where there are a large number of elderly). She eventually had to switch to another position, because it became too much. She said she lost a lot of her empathy for the people who had spent 60-70 years abusing their bodies, and now were just here to slowly die under her care (regardless of how good that care was). She also hated that so many people were kept alive on machines long past the point of having any life left, just to keep the families happy. She said after a while, she could tell the difference... that whatever made a person a person (the soul or whatever you believe in) was gone, and all that was left was a pile of meat being kept "alive" by the machines.

technofiend 8y ago

>One group runs a gauntlet of fire by sleep deprivation during pre-med training: with on-call work hours up to 120 hours a week. I would argue this is the source of injury and death to the patients that needs to be addressed rather than powered through in some sort of macho hazing ritual. Anecdotally a very tired doctor is allegedly how my wife lost her mother.

mfe5003 8y ago
I've always assumed that the failure rate for handing off care to another person and the rate because of long hours must go in favor of long hours. I don't have anything to back this up except the MCAT being designed to check how you perform when tired. Now with electronic records I've been wondering if long hours are still be necessary, assuming I'm right about the failure rates. I'm sorry about your mother in law regardless.
- mattkrause 8y ago
  This is the claim, but if you look at the experiments supporting it, they’re all bonkers. For example, care is no worse from doctors on 28 hr shifts vs 24. I would argue that both of these are so far from a well-rested baseline that they’re meaningless. We know from lab experiments that performance craters way, way before that, which is why pilots, truck drivers, cops, and every other profession work shorter shifts.
  - jchanimal 8y ago
    All this talk is insane. I have like maybe 4 top-performing hours on my best days. The idea of working more than 8 in a life safety critical situation boggles the mind.
- verelo 8y ago
  Super intersting to see people discussing this! As someone that holds a pilots license and talks with a lot of commercial pilots about their jobs, sleep is often a hot topic of discussion. It would be illegal, not just irresponsible, for a pilot to try pull off a 120 hour work week. Why do we treat doctors differently? Their macho behaviour in my opinion is unacceptable, and likely reduces positive patient outcomes, yet it goes on?
  - GavinMcG 8y ago
    Medicine has different concerns than piloting, though. Pilots don't have to ensure continuity of care for their passengers, and can accomplish their work in reasonable chunks. Doubling the number of patient handoffs, on the other hand, significantly increases the risk of one of the more common sources of error.
    - km3k 8y ago
      But could the increase in errors from increased hand-offs be smaller than the increase in errors from sleep-deprived doctors, nurses and patients combined with the increase in disease spread and disease progression from the effect of sleep deprivation on the immune systems of doctors, nurses and patients? Additionally, could there be benefits from getting more eyes on a patient's condition?
    - foobarchu 8y ago
      I've always wondered if the problem might be in the handoff procedures. Those studies about mortality in the event of a handoff always make it sound like obviously handoffs are an inherently dangerous thing, but perhaps the modern way of doing them is just poorly implemented? It feels extremely unlikely to me that absurdly long hours are the only solution.
      - verelo 8y ago
        I think this is a rational question to ask! Often people will jump to conclusions "handoffs cause errors", and while errors are a symptom of handoffs executed poorly, it seems uncommon for people to often ask for improvements to these processes.
Nasrudith 8y ago
Medicine is a conservative field - unfortunately that also includes ignoring anything harmful to their cult aspects even if it is trivially obvious like "wash your hands" after doing a damn autopsy before delivering a baby. Or yes infants can feel pain - not using anesthesia because the control isn't fine enough to not have a better chance of killing them is a grim but justifiable thing initially but inexcusable once it becomes possible to do so safely. And the sleep deprivation and hazing "I did it so everbody else must too!" is definitely a cultic thing. I use cult very deliberately to point at the reasoning being entirely irrational and social as opposed to underlying value. And also because actual cults use slerp deprivation.
IB885588 8y ago
Peter Attia (MD) had a podcast episode where he talked about being a resident and how it almost killed him (asleep while driving) and was bad for patient. Also explained that the guy who created the residency program was a cocaine addict who rarely slept, and since then all doctors have to try to follow his crazy schedule for no good reason..
- ineedasername 8y ago
  Yeah. I mean, I get that hospitals are 24-hour operations that need doctors & nurses available at all times. So some people are going to get the crap end of that stick and have to do night shifts. But is it really necessary for them to work 80+ hours while they're at it? It seems like there's enough people trying to be doctors that you could cut that down to a healthier 40 hours+ 15 hours on call if it's really necessary to. Heck, even 50 hours.
  - pc86 8y ago
    You would likely have to extend residency based on everything that you need to learn for a given specialty. Med school graduates have an average of over $180k in student loan debt - from med school alone - and resident salaries in the 2-4 year programs are mid five figures. Given the choice, I'm not sure someone whose 4-year earning potential is capped at $60k with $200k in student loans would want to extend that to 5/6/7 years.
    - antidesitter 8y ago
      I believe the GP is talking about increasing the number of doctors, not their years in residency.
      - pc86 8y ago
        You learn how to do your entire specialty during residency. If you cut the number of hours, you have the same amount to learn in less time.
da_chicken 8y ago
I used to work in hospital IT at a level 1 trauma center from 2004-2006. While I was there, an article was released which studied the relationship between time on shift and errors made by staff. As I recall (and it has been 10 years) the findings were: * Through roughly 9 hours, the error rate was about the same. Say, x% * In the 10th hour, the error rate increased. Say x + y%. * In hours 11 and 12, the amount the error rate increase doubled the 10th hour's increase. So x + 2y%. * In hours 13 and 14, the amount the error rate increase quadrupled the 10th hour's increase. So x + 4y%. * In every subsequent hour studied, the error rate increase doubled again. x + 8y% in hour 15, x + 16y% in hour 16. I want to say the study went to 18 hours, but I don't recall if it was 16 or 18 at this point. The paper made the recommendation that shift lengths should be limited to 10 hours maximum. Every health care professional I spoke to about the article (resident doctors and nurses, maybe 10 overall, mostly in the ER) said the same three things: 1. They had personally witnessed someone make an error they could attribute to tiredness. 2. They themselves had never made a mistake due to tiredness. 3. They didn't want to change their schedule. Either they liked having 4 days off every week, or they thought it wasn't a significant problem.
- technofiend 8y ago
  2. They themselves had never made a mistake due to tiredness. 3. They didn't want to change their schedule. Either they liked having 4 days off every week, or they thought it wasn't a significant problem. I think those two items and the tribal knowledge that handoffs are more dangerous to the patient helps the overwork model persist. Sounds like it's past time the medical industry prove that handoffs are more dangerous to patient outcomes. Doctors are trained to be problem owners and problem solvers, but that doesn't make them good team players. And lowering handoffs also limits oversight and prevents second guessing which is great if you're convinced you're always right, but clearly doctors are not always right and patients often pay the price.
brahmwg 8y ago
There's been some study(s) which suggest that medical error is the 3rd leading cause of death. This may have been debunked so if wrong please correct me. https://www.cnbc.com/2018/02/22/medical-errors-third-leading-cause-of-death-in-america.html https://www.cnbc.com/2018/02/22/medical-errors-third-leading...
SkyPuncher 8y ago
Many sane minds would argue that, but the ACGME is actively arguing otherwise. They are actively building rules that allow residents to work longer shifts (up to 28 hours straight) while claiming these rules improve patient safety. Patient hand-offs between shifts tends to introduce errors. Instead of finding ways to improve hand-offs, the ACGME is simply trying to have fewer of them. These are supposed to be some of the "top minds" in medicine and that's the best they can come up with.
- technofiend 8y ago
  That's no really addressing the problem, it's just doubling down on the mistaken notion that the treating physician is the best one to tend to the patient under any circumstance. Doctors need to learn to be team players.

spdustin 8y ago

Nurses are a lot more than just shift change workers, and their nursing school requirements are a lot higher than you seem to believe.

yial 8y ago
I don’t think (s)he was commenting on education. I read their comment as only people who can do 12 hour shifts that may be required to occasionally be overnights followed by days, completely disrupting their sleep schedule, can make it as ICU nurses.
Piskvorrr 8y ago
"Works on a shift schedule" is a shared trait between nurses and shift workers. "Has one thing in common with" is not the same as "is the same thing as".
spdustin 8y ago
Parent to that reply edited their post after my comment, and I can no longer edit my reply.

DisruptiveDave 8y ago

To be clear, you're saying that people whose job is to - quite literally - understand, diagnose, and treat hundreds (thousands?) of medical issues that they personally haven't experienced, don't have the capacity to understand that not everyone is on their same sleep schedule?

km3k 8y ago
Yes.
jyounker 8y ago
Doctor's are notorious for not understanding their patients' experiences, and how that impacts them. I've just witnessed this with my partner's recent bout with cancer. While her oncological surgeon completely understands, her reconstructive surgeon had no conception of what she was going through.
LeifCarrotson 8y ago
Those people spent many years learning to understand, diagnose, and treat thousands of medical issues. During that entire time, they were continuously sleep deprived as a matter of culture. Those that could not handle this environment dropped out. They're probably still sleep deprived. They may have learned about sleep's medical effects, but the personal experience of those who survived the selection process who work 120-hour weeks and have been waking patients up once an hour for years has a blinding effect on this diagnosis. It's a bit like bringing someone from south Florida to northern Michigan this winter for some ice fishing. I understand that it's cold here, I intellectually know about, have observed the effects of, and can treat frostbite and other problems resulting from this cold - but all that would make it hard for me to intuit the problems of a visitor who was unable to control their fingers when they removed their gloves and dipped their hands into a minnow bucket to bait a hook. My fingers work fine in that bucket, everyone else on the lake is doing it, you're just going to dry them off in a few seconds and put them back in warm gloves...what's the issue?
- deleted 8y ago
  [deleted]

kerbalspacepro 8y ago

Why do doctors not get sleep? It is still the most ridiculous thing I've ever heard. Start up founders? Fine. Grocery store bagger? I don't care. BUT A PERSON IN CHARGE OF TOUCHING (inside) MY BODY? I want their Fitbit sleep records for the last month showing a consistent 7 hours of sleep.

stevehawk 8y ago
Regarding the U.S., the reality is that it's mostly the students (med students, residents and fellows.. you're called Doctor by residency) that are sleep deprived. After that most doctors are on normal to normal-ish cycles. But because residents and fellows are such solid profit earners for hospitals and the hospital owns their life they opt to over-work them and charge you max dollar for their time. Once the doctor is board certified (post residency or fellowship) then the power shifts back towards the doctor and they can get more normal lives. Exceptions are specializations that are essentially emergency/urgent but even most of them are on rotations like another poster mentioned where they've shifted their own sleep patterns to match their hours. Since watching my friends become doctors (psychiatrists, uroligists, neurointerventional readiology) and my wife become a surgeon I have started telling friends and family "If your doctor looks under the age of 35 then you should ask them the last time they slept before they start treating you. tl;dr : hospitals straight up own the futures of their med students/residents/fellows .. so they overwork them while paying them $40-55k year, and when they aren't working they have to study for their exams.
billfruit 8y ago
Also apart from the Doctors, the military is also notorious for their practice of having too little sleep.
- jartelt 8y ago
  Yes! Sleep deprivation played a role in the two Navy crashes in the last few years.
- topkai22 8y ago
  This is because their job absolutely requires performing on insufficient sleep. Combat isn't shift work. I think (without much data here) that medical training pushes insufficient sleep on doctors due to on-call schedules. While hospitals have doctors, many of their specialists come from private practice or multi-specialty clinics, which rotate being on-call between then (often in 12 hour shifts). The other cause of insufficient sleep is that if a patient under care of doctor has complications, they will often be called, even if just for a consult. Economically, this is likely efficient compared to having hospital specialists (which may end up with nothing to do many nights), but causes docs to train for worst case scenarios sleep-wise.

gerbilly 8y ago

> during pre-med training: with on-call work hours up to 120 hours a week. Can someone please tell me why they still put medical students through this institutional hazing?

pc86 8y ago
Saying that "pre-med training" (whatever that means) consists of 120 hour work weeks is not accurate but it's probably just because we're using the wrong words. Pre-med = college, and aside from the highly scientific work load is no different than any other college experience. Medical school (no longer called "pre-med" by anyone) is typically 2 years of classes and 2 years of clinical rotations. The rotations are not going to be 120 hours a week but may be 60-80. But unless you go to a teaching hospital and consent to student contact (which may or may not be a requirement of treatment) no med school student is touching you. Residency is after med school (they're full doctors now) where you train your specialty, and at least in the 4 year program I'm familiar with, their title is intern, resident, resident, senior resident for each of the four years. They have increasingly high levels of responsibility as they progress and by the 4th year they are basically oversight/management of the other residents who assist on complex cases and bring in at attending physician(s) for big stuff. Hours are typically 80+ and I'm sure you could approach 100 for very demanding or emergent specialties but it's certainly not "pre-med training" and 120 is pushing it for sure. After you graduate residency you move to an attending, fellowship, or research position and the hours drop back down to the 60-70 range and decrease as you gain seniority.
- jyounker 8y ago
  And on top of those 60-80 hours per week you need to add all the time prepping for exams and boards, correct? That study time is work too, and that pushing up to 120 hours per week.
jac241 8y ago
In medical school, 120 hour weeks really only exist for 4th year med students who are on sub-internships in surgical specialties like neurosurgery, orthopedic surgery, general surgery, etc. Students in those fields do 3 or so month long sub-i's at hospitals they want to do residency at. They basically function as month long interviews for those programs, and are also used to get letters of recommendation from prominent faculty in the field. People who are interested in those fields know about the hour requirements on sub-i's and in residency, and self-select in a way. The reason resident physicians work so much is because residents make $60k working 80+ hour weeks, and the PAs or NPs who would be willing to cover the floors at night would make $150k+ working 40hrs/wk. Residents also have no collective bargaining power because of the residency match system. You can't easily leave one program and go to another because you don't like the working conditions, for example. If you want to leave, you're more or less blackballed unless you're switching fields. And you don't want to speak up about the conditions because you've got $300k in debt and a degree that's useless until you finish residency.

cowpewter 8y ago

My mom was an ICU nurse for over 20 years, and yeah, the burnout is real. My mom always said that ICU is made up of a very small number of surgery recovery patients (who quickly get moved to a different section once they're past the critical part of their recovery), and the rest is people who are just there to die (especially here in Florida, where there are a large number of elderly). She eventually had to switch to another position, because it became too much. She said she lost a lot of her empathy for the people who had spent 60-70 years abusing their bodies, and now were just here to slowly die under her care (regardless of how good that care was). She also hated that so many people were kept alive on machines long past the point of having any life left, just to keep the families happy. She said after a while, she could tell the difference... that whatever made a person a person (the soul or whatever you believe in) was gone, and all that was left was a pile of meat being kept "alive" by the machines.