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> .. it cut into the 100-hour-plus weeks that were often the norm for surgical trainees. Serious question: how are these surgeons still awake after one month w

> .. it cut into the 100-hour-plus weeks that were often the norm for surgical trainees. Serious question: how are these surgeons still awake after one month without resorting to stimulants and other medications? That would be 20h a day, with weekends, or 14h+ a day, every day with no break. If you drive more than about 9h in one go, at least around here, you're considered a threat for others on the street and unfit to drive. But US surgeons are considered high quality after working 14h?

firstplacelast 3y ago
As far as I am aware, it is time at the hospital. So they can sleep a bit, but it is not much. These are smart people, they do not want it to change. Their income would decrease if more people were trained/brought in. Have a lot of physician friends, it's awful and they complain, but are worried about wages. They do not want to make less. A big part is the expense of undergrad+med school+low residency wages+most grew up upper-middle class and have big expectations. They're very worried about losing ground wage-wise. which is fair in my opinion...they have a de facto union/guild (like most smart people who earn a wage try to do).
- ToucanLoucan 3y ago
  > These are smart people, they do not want it to change. Somewhat undercut by the rampant suicide rate. > A big part is the expense of undergrad+med school+low residency wages+most grew up upper-middle class and have big expectations. Oh so when you say "they don't want things to change" what you mean is "they know the path to success and if they try to take care of themselves or demand decent working conditions there's a good chance they'll be fired and end up bankrupt and in a debt trap for life." Got it. That kind of explains the suicides.
- pcdoodle 3y ago
  Dang, I don't know if I want someone with life work balance skewed in the "sleeping odd hours, suicidal, needing the money" favor poking around in my body.
- deng 3y ago
  Well, ask two doctors and you'll get three opinions about work time. From my experience here in Germany: - Doctors in training usually want to work as much as possible to finish their training as fast as possible, especially if they want to work in surgery. For instance, if you train for "general surgery", you need to do about 25 appendectomies, about 35 cholecystectomies, and so on. So in a perverse way, you need a bit of "luck" that you are working while these cases come in. More time in the hospital simply increases your luck. - Young doctors without kids often want to work a lot to earn more money and accelerate their career. - Older doctors with kids usually want to work less and more flexibility for choosing shifts.
  - taurath 3y ago
    Here in the US that usually means they’ve got $200-300k in student loan debt to pay off the moment they start their residency
    - ProllyInfamous 3y ago
      I began US med school well over a decade ago, so my POV is dated (pre-ACA). I dropped out very early into my formal training. However, I still keep up with three people whom completed grad school; two physicians, and one dentist (all practice medicine, now, except me). Remembering their almost-simultaneous relief as each paid off their final $xxx,xxx student loan... the dentist still has to pay off his "Practice" financing (office), but all texted me upon the first deposits of their "first big-boy paychecks" — proud to finally be tackling this debt. Two of the three have confided to me that "I am smarter than all three of them, having left medicine early [enough to pay off only $109k of student loans]." I always thank medical staff, whatever the rank, for having to deal with the public. My dentist friend admits to never having-considered that his stubby fingers would have to work in tinier mouths (relative to normal hands). C'est la vi.
  - yomlica8 3y ago
    > - Doctors in training usually want to work as much as possible to finish their training as fast as possible, especially if they want to work in surgery. For instance, if you train for "general surgery", you need to do about 25 appendectomies, about 35 cholecystectomies, and so on. So in a perverse way, you need a bit of "luck" that you are working while these cases come in. More time in the hospital simply increases your luck. Sounds like a great way to incentivize tons of unnecessary surgeries as well.
deng 3y ago
These hours usually include stand-by time. If you work in a job like this, with time you usually learn to fall asleep very quickly, whenever, wherever. This will keep you at least functioning to some degree. You will miss a lot of slow-wave sleep compared to people with a normal routine, and that surely is one of the reasons people in these kind of jobs often struggle with mental health.
- nairboon 3y ago
  > with time you usually learn to fall asleep very quickly Can that really be learned or is that a sign of a serious circadian rhythm dysfunction? A healthy human body doesn't just sleep at a moment's notice, that only works when the clock is broken.
  - deng 3y ago
    This can definitely be learned in a methodical way, this is very common in the military, for instance. Of course, this will usually not work when you are wide awake and not sleepy at all, but in that case it is also not needed. So you are not wrong: this is for times when you simply cannot have a normal sleep schedule, for instance during a military operation or while doing a multi-day shift at the hospital, where you are practically always sleep-deprived. In the military, this is methodically trained specifically for these situations, in a civilian setting it will often simply develop naturally, out of necessity.
    - brianwawok 3y ago
      Many new parents develop this strategy, which thankfully goes away in about 2 years.
instagib 3y ago
Drugs or power naps. Two quotes stood out for me. Years of experience teaching them how to deal with it. “50 years ago … physicians had rates of narcotic addiction 30 to 100 times higher than the general population, and about 100 doctors a year in the US died by suicide.” “They are taught, throughout a decade of grueling training, to dissociate themselves from their body’s natural cues, telling them that it is time to rest, eat or urinate.” I’ve done a lot of long hours before in engineering work. I found that at 13 hours I am significantly impaired. I’ve done 16-24hr days and caffeine stops working the same way around 16 hours. Ephedrine can get you some more time or the adrenaline of a stressful situation. 80-100 hour work weeks for years is crazy for residents. Work is their life. They may not even go home in between shifts. They can do some key drop power naps or navy seal power naps. My cousins are in the field and Maslow’s pyramid is a constant conversation topic. I’m sure there are some military manuals or doctor support forums you could research further. “This is going to hurt” is a good window into the field. Book/tv series.
- taurath 3y ago
  It’s horrifying and also just accepted and pushed constantly by established doctors and administrators. It’s the same as teaching - only the most zealous will ever survive, because they’re the only one that will put up with the conditions.
- hinkley 3y ago
  Ephedrine will let you go until you die.
deleted 3y ago
[deleted]
hombre_fatal 3y ago
My brother-in-law is an ER doctor who will get long shifts, especially overnight ones, where he's sleeping in the hospital bunker until he's needed. He said it's not a problem for him. I had similar questions for him just last month. He pointed out that working so much keeps his critical skills really sharp which is what you want when you're doing surgery/emergency. I suppose when you get woken up to intubate someone, you want it to be second nature rather than a faded skill you practice every couple months because you dropped down to saner hours. But he's also paid hundreds of thousands of dollars to do that. Fun fact: he said one of the most preventable deaths he sees in the ER is people choking on food alone in their home. I think about that every time I almost choke to death on some gooey cheese. Make sure to chew well, folks.
- ProllyInfamous 3y ago
  I dropped out of US med school after my intro ER rotation, over a decade ago (pre-ACA). It is my opinion that you simply cannot pay a US-trained physician (I have no outside perspective) enough money for the inhuman sacrifices required, simply to take care of (y)our lazy asses... =D My electrician career averaged less than 40 hours per week, and four-day workweeks were our norm. Life is nothing but sacrifices for an acceptable level of self-decided laziness/relaxation.
- boppo1 3y ago
  That's scary. I was recently struggling with some peanut butter (I often eat it directly) and had the thought 'could I wind up choking? Nah, no way'. Spooky.
- jstarfish 3y ago
  > Fun fact: he said one of the most preventable deaths he sees in the ER is people choking on food alone in their home. I think about that every time I almost choke to death on some gooey cheese. Make sure to chew well, folks. I normally advocate not living alone (slip-and-falls are also a concern; only god can help you if you have a stroke), but if you insist, take the Red Cross CPR class. It's cheap/free, a few hours long, will teach you how to resuscitate anything, and most importantly...how to perform the Heimlich on yourself.
tnecniv 3y ago
I watched all of ER a few years back. There was only one episode where a doctor killed Simone by mistake because they were stuck there way longer than they should have been due to a staffing issue. However basically from the opening of the first episode, how exhausted all these doctors are is hammered home.
- pschuegr 3y ago
  poor Simone
CobaltFire 3y ago
The career I just retired from was routinely 14-16 hour days, 7 days a week, for months or years on end with maybe a couple weeks off. You get into a weird mental space where you are halfway auto pilot and halfway conscious, and your brain has a really hard time staying focused without being forced to. Hard to explain, but if you’ve been there it makes sense. Note that this was working, among other places, on nuclear reactors and on flight decks in the US Navy. This is absolutely normal there, and those are fairly dangerous places to be.
20after4 3y ago
They prescribe themselves stimulants?
- theGnuMe 3y ago
  I don't think you are allowed to self prescribe.

firstplacelast 3y ago

As far as I am aware, it is time at the hospital. So they can sleep a bit, but it is not much. These are smart people, they do not want it to change. Their income would decrease if more people were trained/brought in. Have a lot of physician friends, it's awful and they complain, but are worried about wages. They do not want to make less. A big part is the expense of undergrad+med school+low residency wages+most grew up upper-middle class and have big expectations. They're very worried about losing ground wage-wise. which is fair in my opinion...they have a de facto union/guild (like most smart people who earn a wage try to do).

ToucanLoucan 3y ago
> These are smart people, they do not want it to change. Somewhat undercut by the rampant suicide rate. > A big part is the expense of undergrad+med school+low residency wages+most grew up upper-middle class and have big expectations. Oh so when you say "they don't want things to change" what you mean is "they know the path to success and if they try to take care of themselves or demand decent working conditions there's a good chance they'll be fired and end up bankrupt and in a debt trap for life." Got it. That kind of explains the suicides.
pcdoodle 3y ago
Dang, I don't know if I want someone with life work balance skewed in the "sleeping odd hours, suicidal, needing the money" favor poking around in my body.
deng 3y ago
Well, ask two doctors and you'll get three opinions about work time. From my experience here in Germany: - Doctors in training usually want to work as much as possible to finish their training as fast as possible, especially if they want to work in surgery. For instance, if you train for "general surgery", you need to do about 25 appendectomies, about 35 cholecystectomies, and so on. So in a perverse way, you need a bit of "luck" that you are working while these cases come in. More time in the hospital simply increases your luck. - Young doctors without kids often want to work a lot to earn more money and accelerate their career. - Older doctors with kids usually want to work less and more flexibility for choosing shifts.
- taurath 3y ago
  Here in the US that usually means they’ve got $200-300k in student loan debt to pay off the moment they start their residency
  - ProllyInfamous 3y ago
    I began US med school well over a decade ago, so my POV is dated (pre-ACA). I dropped out very early into my formal training. However, I still keep up with three people whom completed grad school; two physicians, and one dentist (all practice medicine, now, except me). Remembering their almost-simultaneous relief as each paid off their final $xxx,xxx student loan... the dentist still has to pay off his "Practice" financing (office), but all texted me upon the first deposits of their "first big-boy paychecks" — proud to finally be tackling this debt. Two of the three have confided to me that "I am smarter than all three of them, having left medicine early [enough to pay off only $109k of student loans]." I always thank medical staff, whatever the rank, for having to deal with the public. My dentist friend admits to never having-considered that his stubby fingers would have to work in tinier mouths (relative to normal hands). C'est la vi.
- yomlica8 3y ago
  > - Doctors in training usually want to work as much as possible to finish their training as fast as possible, especially if they want to work in surgery. For instance, if you train for "general surgery", you need to do about 25 appendectomies, about 35 cholecystectomies, and so on. So in a perverse way, you need a bit of "luck" that you are working while these cases come in. More time in the hospital simply increases your luck. Sounds like a great way to incentivize tons of unnecessary surgeries as well.

deng 3y ago

These hours usually include stand-by time. If you work in a job like this, with time you usually learn to fall asleep very quickly, whenever, wherever. This will keep you at least functioning to some degree. You will miss a lot of slow-wave sleep compared to people with a normal routine, and that surely is one of the reasons people in these kind of jobs often struggle with mental health.

nairboon 3y ago
> with time you usually learn to fall asleep very quickly Can that really be learned or is that a sign of a serious circadian rhythm dysfunction? A healthy human body doesn't just sleep at a moment's notice, that only works when the clock is broken.
- deng 3y ago
  This can definitely be learned in a methodical way, this is very common in the military, for instance. Of course, this will usually not work when you are wide awake and not sleepy at all, but in that case it is also not needed. So you are not wrong: this is for times when you simply cannot have a normal sleep schedule, for instance during a military operation or while doing a multi-day shift at the hospital, where you are practically always sleep-deprived. In the military, this is methodically trained specifically for these situations, in a civilian setting it will often simply develop naturally, out of necessity.
  - brianwawok 3y ago
    Many new parents develop this strategy, which thankfully goes away in about 2 years.

instagib 3y ago

Drugs or power naps. Two quotes stood out for me. Years of experience teaching them how to deal with it. “50 years ago … physicians had rates of narcotic addiction 30 to 100 times higher than the general population, and about 100 doctors a year in the US died by suicide.” “They are taught, throughout a decade of grueling training, to dissociate themselves from their body’s natural cues, telling them that it is time to rest, eat or urinate.” I’ve done a lot of long hours before in engineering work. I found that at 13 hours I am significantly impaired. I’ve done 16-24hr days and caffeine stops working the same way around 16 hours. Ephedrine can get you some more time or the adrenaline of a stressful situation. 80-100 hour work weeks for years is crazy for residents. Work is their life. They may not even go home in between shifts. They can do some key drop power naps or navy seal power naps. My cousins are in the field and Maslow’s pyramid is a constant conversation topic. I’m sure there are some military manuals or doctor support forums you could research further. “This is going to hurt” is a good window into the field. Book/tv series.

taurath 3y ago
It’s horrifying and also just accepted and pushed constantly by established doctors and administrators. It’s the same as teaching - only the most zealous will ever survive, because they’re the only one that will put up with the conditions.
hinkley 3y ago
Ephedrine will let you go until you die.

deleted 3y ago

[deleted]

hombre_fatal 3y ago

My brother-in-law is an ER doctor who will get long shifts, especially overnight ones, where he's sleeping in the hospital bunker until he's needed. He said it's not a problem for him. I had similar questions for him just last month. He pointed out that working so much keeps his critical skills really sharp which is what you want when you're doing surgery/emergency. I suppose when you get woken up to intubate someone, you want it to be second nature rather than a faded skill you practice every couple months because you dropped down to saner hours. But he's also paid hundreds of thousands of dollars to do that. Fun fact: he said one of the most preventable deaths he sees in the ER is people choking on food alone in their home. I think about that every time I almost choke to death on some gooey cheese. Make sure to chew well, folks.

ProllyInfamous 3y ago
I dropped out of US med school after my intro ER rotation, over a decade ago (pre-ACA). It is my opinion that you simply cannot pay a US-trained physician (I have no outside perspective) enough money for the inhuman sacrifices required, simply to take care of (y)our lazy asses... =D My electrician career averaged less than 40 hours per week, and four-day workweeks were our norm. Life is nothing but sacrifices for an acceptable level of self-decided laziness/relaxation.
boppo1 3y ago
That's scary. I was recently struggling with some peanut butter (I often eat it directly) and had the thought 'could I wind up choking? Nah, no way'. Spooky.
jstarfish 3y ago
> Fun fact: he said one of the most preventable deaths he sees in the ER is people choking on food alone in their home. I think about that every time I almost choke to death on some gooey cheese. Make sure to chew well, folks. I normally advocate not living alone (slip-and-falls are also a concern; only god can help you if you have a stroke), but if you insist, take the Red Cross CPR class. It's cheap/free, a few hours long, will teach you how to resuscitate anything, and most importantly...how to perform the Heimlich on yourself.

tnecniv 3y ago

I watched all of ER a few years back. There was only one episode where a doctor killed Simone by mistake because they were stuck there way longer than they should have been due to a staffing issue. However basically from the opening of the first episode, how exhausted all these doctors are is hammered home.

pschuegr 3y ago
poor Simone

CobaltFire 3y ago

The career I just retired from was routinely 14-16 hour days, 7 days a week, for months or years on end with maybe a couple weeks off. You get into a weird mental space where you are halfway auto pilot and halfway conscious, and your brain has a really hard time staying focused without being forced to. Hard to explain, but if you’ve been there it makes sense. Note that this was working, among other places, on nuclear reactors and on flight decks in the US Navy. This is absolutely normal there, and those are fairly dangerous places to be.

20after4 3y ago

They prescribe themselves stimulants?

theGnuMe 3y ago
I don't think you are allowed to self prescribe.