Sunday, July 10, 2011

Work hour rules

I have some friends still in residency and I've been discussing the new intern work hour restrictions with them. In case you haven't heard, the new ACGME rules restrict interns to working more than 16 hours per shift.

When I was an intern, we did 30 hour calls. After being awake for 30 hours, my brain was really fried, and like studies have shown, I both felt and acted slightly drunk. So I agree that 30 hour calls are not a great idea.

My residency program, trying to be progressive, switched the interns to 16 hour calls at the end of my intern year. So I have some experience with this.

Funnily enough, as much as we hated the 30 hour calls, we didn't like the idea of switching. We didn't like the idea of doing hand-offs and had come to believe that there was education in following a patient through their first 24 hours after admission. Plus we got to be post-call the next day, which was especially nice when we had an easy call where we got 5-6 hours of sleep.

Unfortunately, the 16 hour shifts were kind of a disaster. The big problem was that the interns couldn't get their work done in 16 hours. So instead of leaving by 10PM, they would end up leaving at midnight or later, and not get the requisite 8 hours off before returning to work.... and then have to put in a full day of work the next day.

And it only got worse when the new interns started, who were more slower and more inefficient.

Ultimately, I think the 16 hour shifts are a good idea, but I don't know if it will necessarily make life easier for interns. Unless programs are really strict about getting interns home after 16 hours, I suspect that there are going to be a lot of interns who end up basically working most of the night and then not even being post-call the next day.


  1. My friend who just finished her intern year was going on a tirade about how horrible the new work hours were going to be for patient care because you'd never be able to follow a patient over night after you admitted them.

    Personally, I think this is BS. On my sub-i we had a 6 day rotating call schedule with short, post-short, medium, post medium, and long, post long. On short call days you admitted from 8-12, medium 12-5, and long 5-10. You switched off with the other intern on who took the over night so you only did 24 hours on every 12th night. The night float system was pretty good, and I never felt like I had any problems following may patients after they were admitted because on long call your TEAM would follow the patient rather than the nightfloat. Plus on most days you admit during the day, so you have plenty of time to follow people before you go home anyway. On non-long call days, we'd sign out to the night float by 6PM. The only thing that sucked about that was you could never go home early if you finished your work early. But that practically never happened for me anyway.

    I think people get very wed to the idea that the way they did things back in their day is the ONLY right way. I'm impressed that you've been able not to fall into that trap. :-)

  2. You are totally right when you say that interns can't get all their work down in 16 hours days. I am a new intern and on long call days we are supposed to leave by 10pm, but often it is much later. I know other interns are leaving as late as midnight and 1am only to have to return at 5/6am. I would much rather prefer having a post-call day

  3. More slower? :) You had me scratching my head and contemplating that one for a second.

  4. I'm still in my internship here in the Philippines. Because my batch has the smallest number of interns in the history of my university (4/group), we get to have 24-hour duty every other day for our IM and OB rotations, which pretty much means we go on 34-hour shifts, go to sleep on our own beds for 1 night, and go back to the hospital the next morning. It's every 3 days for surgery and pedia. I feel like a zombie most days. But I learned stuff I wouldn't have learned if it had been a bit easier. :)

  5. OMDG: It's very weird how everyone clings to the way they were trained, as if it's the only right way.

    Caligirl: Exactly. And some interns can't even do it by June.

    c4d3: Sometimes typos make things incomprehensible, but I thought it was pretty clear what that sentence meant. Is English not your first language?

    canarintha:You may be right about learning but the purpose of the laws is to protect patients.

  6. Caligirl: Same at my program. That is exactly what is happening to us...not getting some post-call rest because of the "shifts."

    In terms of continuity, we definitely do follow our patients after admission and I saw a lot of the people I had admitted say three days ago when I was on call then.