The standard for full-time employment was typically 40 hours a week in the past. While physician sentiment toward long work hours has undoubtedly softened, many doctors, often those who trained in an era without restrictions on work hours, still question whether doctors today are trained as well as they used to be. The findings contribute to current concerns about the epidemic of burnout among physicians. Then consider seeking a residency at an academic medical center and try to find a research mentor. California employers must pay overtime to nonexempt employees for all hours worked over 8 hours per day, or 40 hours per week. Even with caps on hours worked, it’s not uncommon to go beyond this amount. Many ob-gyns work 4 days per week, or sometimes half-time. In 2009 one physician wrote to the editor of the New England Journal of Medicine that, as a result of the 2003 reforms, “We now force [residents] to leave a patient with whose treatment they are intimately involved or to cease the observation of an instructive surgical procedure midstream. What’s the weekly workload in terms of hours worked during an Internal Medicine residency? Usual hours worked refers to the number of hours that a person usually works in a typical week, regardless of whether he is paid or not. However, keep in mind that these rules specify a weekly limit that is averaged out over four weeks. The answer: not much. The current work conditions vary drastically from the old days when the number of hours worked per week were 100 – 120. The law was named after Libby Zion, who died in 1984 at the age of 18 under the care of what her father believed to be overworked resident physicians and intern physicians. You will be board-certified if you graduate from any accredited program! Among the respondents, 834 residents (3.3% of the responding residents) in 370 programs (24.8% of responding programs) reported working more than 80 hours per week during the previous 4 weeks. Today the average resident finishes with around 900 operative cases. This study — a… She currently resides in Galveston, TX with her husband and two young daughters. Many programs are shifting now to various block schedules (4+1, 3+1, etc) meaning you get a week or two of clinic every few weeks to break up the long days on the hospital shifts. Amy Rakowczyk is a medical spouse, mother, writer, singer, and former voice instructor. However, even with caps on hours worked, it’s not uncommon to go beyond this amount. An 80-hour workweek seems sufficient for training a doctor. “The length of the work day fell sharply between the 1880s, when the typical worker labored 10 hours a day, 6 days a week, and 1920, when his counterpart worked an 8-hour day, 6 days a week. This is pretty standard for most surgical interns. When you are working inpatient, your hours worked per day can be quite long. In 2003 new reforms prohibited resident doctors from working more than 80 hours per week and limited shift lengths to 24 hours. level 1 Generally, an employee can work more than 48 hours in a work week only if he or she has agreed electronically or in writing and was provided with the document entitled “Information for Employees About Hours of Work and Overtime Pay,” published by the Director of Employment Standards, before the agreement was made. There are a few key elements that vary between IM/Med-Peds and Family Medicine. We log every week exactly as we worked. Comparing doctors who completed their training before 2006 with those who completed theirs after it, 30-day mortality rates for hospitalized patients treated by first-year internists fell from 10.7% to 9.9%, a change that could incorrectly be used to argue that working fewer hours in residency led to better-trained doctors. We looked at the same three patient outcomes for these doctors, who were never exposed to work-hour restrictions during their residency training. It’s best to begin by exploring what’s important to you and then look for that in the program. Do you envision your future as a faculty member at an academic medical center? Typically the work week for someone working full-time is 40 – 60 hours plus one to two nights of call per month. How would that happen if it’s not allowed? Do medical doctors based in the U.S. really need to work crazy hours (80-120+) per week for several years during residency to be effective doctors? However, highly respected and top-rated program are quite competitive to match into. Since 2017, when the latest reform was implemented by the Accreditation Council for Graduate Medical Education, the cap remains 80 clinical … These reforms were arguably the largest natural experiment in the history of modern medical training. But for many doctors the 2003 reforms raised concerns that the quality of medical training would be diminished by a shift-work mentality, an erosion of professionalism, and an inability of doctors-in-training to witness firsthand the hour-by-hour progression of a critical illness, all of which may lead doctors to have less experience on which to base future treatment decisions and insufficiently prepare them for the long hours and patient commitments required in real-life practice. Residency will challenge you in unexpected ways. Internal Medicine is a broad speciality that encompasses foundational medicine training (often called categorical training) as well as many sub-specialities such as Cardiology, Gastroenterology, and Infectious Disease. Medical resident work hours refers to the (often lengthy) shifts worked by medical interns and residents during their medical residency. According to the American College of Physicians, Internal Medicine is a science that represents the best of both worlds. There may also be periods of study or research, which are much more relaxed in terms of schedule. Well-known academic centers tend to have good track records for matching their resident graduates into sub-specialty fellowships. New York State was 15 years ahead on this, having mandated an 80-hour work week in 1989, stemming from the Libby Zion case. You summed it all up very nicely! Residents refer to Singapore Citizens and Permanent Residents. You will need some downtime when possible. Your key to success will be having some systems in place. Long and unpredictable work hours have been a staple of medical training for centuries. Med-Peds (Internal Medicine and Pediatrics), EM-IM (Internal Medicine and Emergency Medicine), or Internal Medicine and Psychiatry are examples of dual training programs. Lastly, consider the general mindset that is instilled into people who train in FM versus IM, and how you tend to think about medicine as well. According to studies and resident reports, 80+ hours per week is normal for this type of residency. For a better experience, please enable JavaScript in your browser before proceeding. In the U.S. it requires four years of college followed by four years of medical school and, depending on the specialty, three or more years of residency training, a period when doctors routinely work up to 80 hours a week. In accordance with the new common program requirements dated July 1, 2011: as of July 1, 2011 the following requirements apply to the Internal Medicine Residency Training Program at Vanderbilt: 1. In general, IM is considered a less competitive speciality, simply because the number of positions available to match into is very large compared to other specialties. However, many employers now consider employees as full-time when they work fewer hours (i.e., over 30 hours, 35 hours, or 37.5 hours). On days worked, employed men worked an average of 34 minutes more than employed women - this difference may be on account of women’s higher instance of part-time work (there were almost twice as many part-time female employees as there were part-time male employees). One common question that arises is what the difference is between doing an Internal Medicine (IM), Med-Peds, or Family Medicine (FM) residency. and via an electronic resident survey collected data on duty hour compliance from 25,176 residents in 1,489 programs. It is one of the largest specialities in terms of numbers of residents. They found that a person who has stayed awake for 24 hours functions with the same diminished cognitive skill of someone with a blood alcohol level of 0.10. Internists (and pediatricians) spend a much larger portion of their core training in the hospital setting compared to FM physicians.Â. but then it’s one of the exceptions. This is particularly relevant today, as any small gaps in an individual doctor’s expertise can likely be mitigated by the increasingly team-based nature of medical care and the growth in health care technologies, including electronic health records and various safety systems. ED Shifts are either 10 or 12 hours in length and are either 7 am to 7 pm or 7 pm to 7 am. It may be hard to imagine why many in the medical profession would have believed that an additional 10 to 20 hours in the hospital each week would make for a better-trained doctor. It may then come as a surprise that becoming a doctor is actually easier than it used to be, at least in terms of time spent on the job. In a study published in the BMJ, my colleagues and I analyzed the outcomes of nearly 500,000 hospitalized patients in the U.S. who were treated by newly independent doctors with varying exposure to work-hour restrictions during their residency training. Amount of hours worked per week varies between each rotation, however, typically a resident can expect to work about 50-60 hours a week. Under the ACA, employees who work 30 or more hours per week are entitled to health insurance; however, beyond that, companies may … What is the difference between a physician who is intoxicated and one who has not slept in 24 hours? Residents want the work experience, and there are often work cultures that … When you’re in clinic seeing patients, it’s possible to follow a more typical 8-10 hour day. For example, Geriatrics and Palliative Medicine are often accepting of residents from both fields. Harvard Business Publishing is an affiliate of Harvard Business School. California. ED and Admitting Resident Rotation. (These outcomes were patient mortality and readmission to the hospital within 30 days of being hospitalized, as well as the costs of care.) Some academic medical centers reserve a portion of their fellowship positions for residents at their own institutions. One surgeon noted in a recent article, “When I trained, good or bad, I worked about 120 hours a week. These podcasts provide not only inside looks into IM and discuss various medical topics, but can also bring some humor and perspective into the daily grind of residency. While physician sentiment toward long work hours has softened, many doctors, often those who trained in an era without restrictions on work hours, still question whether doctors today are as well-trained as they used to be. Let’s take a look at what IM is and what you can expect from an IM residency. The employee may therefore be expected to work more than 45 hours per week. However, even with caps on hours worked, it’s not uncommon to go beyond this amount.Â, How would that happen if it’s not allowed? Becoming a doctor has always been difficult. Employees who earn above the determined threshold amount must negotiate the normal amount of working hours per day or per week with the employer. According to studies and resident reports, 70-80 hours per week during hospital rotations and 40-50 hours per week on outpatient clinic rotations is normal for this type of residency. Some programs follow a more traditional schedule which consists of hospital rounds in the morning and clinic in the afternoons. Most contracts stipulate a maximum number of consecutive hours that can be worked. But a similar decline was observed for 10th-year internists, whose patient mortality rates fell from 11.2% to 10.4%. There is no one-size-fits all for each doctor or each program. Traditional Standard Workweek . I finished with twice as many.”. You are using an out of date browser. We found that newly independent doctors who trained in a period where their residency work hours routinely reached 90 to 100 hours per week had no better patient outcomes, despite the additional hours spent in training, than doctors whose residency training involved substantially less time in the hospital. And with rates of physician burnout increasing in recent years, it’s worth considering whether residency work hours could be reduced further, or restructured to address other causes of fatigue (such as electronic health records and insurance issues), without compromising clinical expertise and quality of care for patients downstream. Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in- house call activities and all moonlighting. She enjoys helping other spouses navigate the world of medicine and actively participates in support groups and activities. Her hus... Amy Rakowczyk is a medical spouse, mother, writer, singer, and former voice instructor. Internal Medicine tends to focus on generating expertise in diagnostic skill and medical knowledge. Most residents will complete 14-15 ED shifts over the 4-week rotation. What are some strategies you can put into place to help you de-stress and relax? Residents want the work experience, and there are often work cultures that encourage residents to under-report their hours so that they don’t “rock the boat.”. A. On the other hand, if you’re not sure if you want to sub-specialize or do a lot of research, or if there is a program close to home or that has a reputation for treating its residents well, don’t shrug these off as sub-par or undesirable. We had 4 medicine residents covering 200+ patients with 15-20 new admits a night. In order to handle the long hours, stress, and physical requirements of the profession, work to avoid spending 100% of your time and energy on your residency. Because mortality fell by a similar amount for both the treatment (doctors who worked 80-hour weeks) and the control group (doctors who worked 100 hours), the decline can’t be attributed to hours of training and is more likely due to hospital quality improvements. If you know you want to do general medicine in the outpatient setting for all ages, strongly consider Family Medicine. Spend some time around doctors in both of these fields and get the feel for this difference. At a minimum, the data suggests that the incremental experience gained from working more than 80 hours per week as a resident doctor doesn’t generally translate into improved patient outcomes later. If the intense nature of residency training is a prerequisite for doctors to deliver high-quality care once they enter independent practice, simply because a large number of hours spent treating patients is absolutely necessary for clinical expertise, then it may be difficult to further reduce resident work hours without compromising downstream quality of care. These reforms were hotly contested. Analyzing the outcomes of nearly 500,000 hospitalized patients in the U.S., they found that newly independent doctors who trained in a period where they routinely worked 90 to 100 hours per week had no better patient outcomes, despite the additional hours spent in training, than doctors whose residency training involved substantially less time in the hospital. Time working in actual hours spent is very program dependent and rotation/service dependent. To account for the fact that overall hospital care has improved over time, we used as a second control group doctors who completed residency 10 years earlier. On the other hand, additional training may be at the “flat of the curve,” meaning extra hours spent in the hospital offer little marginal benefit in terms of added expertise. B. Moonlighting (internal or external) must not interfere with the ability of the resident to achieve the educational goals and objectives of the residency program. However, your choice of fellowship options will be strongly affected by the residency you choose. I work on average 70-80 hours per week, with an average of one day off per week, depending on the rotation. You can’t work more than 48 hours a week on average - normally averaged over 17 weeks. This was a "cush" private hosptial. Sometimes these fellowship programs don’t hire from within. JavaScript is disabled. You’ll need a regular exercise routine, time to socialize outside of work, and time to read or enjoy things that are not related to your residency. Some programs may try to observe resident duty hour rules more strictly. If you want to leave the door open to a wider number of sub-specialty fellowships, consider Internal Medicine. If you end up doing either general hospitalist work or outpatient work, it may not matter much which path you took in residency. Are you planning to sub-specialize? What are some healthy activities you can do? 1. How would that happen if it’s not allowed? According to studies and resident reports, 70-80 hours per week during hospital rotations and 40-50 hours per week on outpatient clinic rotations is normal for this type of residency. Each resident has a minimum of 10 hours between shifts. Sounds crazy but you basically work 3 days and 2 nights with a few 20-30 min naps between calls at night and then maybe go home to shower and get a solid 4 hours 1-2 times a week. Full-time refers to employment where the normal hours of work is at least 35 hours a week. They care for only an adult population and can work in the both hospital and outpatient setting. Hours worked per week Days off per week Vacation weeks per year Dermatology 45.0 1.9 … Maximum hours worked per week: Duty hours must be limited to eighty hours, … Our findings relate to the current epidemic of burnout among physicians — more than 40% of U.S. physicians reported experiencing burnout in several studies — a phenomenon that often starts during the busy years of residency training. Many doctors worried that the reduction of training hours would hurt the quality of medical training, erode professionalism, and hurt new doctors’ ability to witness firsthand the hour-by-hour progression of a critical illness — all of which could lead doctors to have less experience on which to base future treatment decisions and insufficiently prepare them for the long hours and patient commitments required in real-life practice. Check them out: Best of luck to you as you make your decisions and apply for Match! California’s overtime rules apply to California residents as well as out-of-state nonexempt employees temporarily working in California. Likewise, FM physicians can go on to do hospitalist work, but it might take some extra effort and/or training to catch up to their IM peers in the hospital (depending on the individual’s residency program of course). France. ED shifts are 7 days a week. France has a slightly … We similarly found that spending fewer hours in the hospital during training had, on average, no effect on internists’ hospital readmission rates or costs of care when they subsequently entered independent practice. Family Medicine tends to give more space to developing people skills, communication skills, and a public health or community health perspective. Most Sports Medicine fellowships require a FM residency. In a new study, researchers found that an 80-hour workweek seems sufficient for training a doctor. By 1940 the typical work schedule was 8 hours a day, 5 days a week. New York State Department of Health Code, Section 405, also known as the Libby Zion Law, is a regulation that limits the amount of resident physicians' work in New York State hospitals to roughly 80 hours per week. But they were hotly contested. However, be sure to ask how many of their current fellows in your desired sub-specialty graduated from their internal medicine residency. You can also talk to your residency director about programs and resources to help residents handle burnout and stress, or deeper issues like depression, substance abuse, or other unhealthy behaviors. If you’d like to work in the hospital setting with adults and children, or want to leave the door open to work with children outside the hospital in addition to adults, you may want to consider Med-Peds. If you dream of going into Cardiology, finding a program that hosts a large Cardiology fellowship program could boost your chances of landing that dream job. It did not take long for this system to produce residents who would either walk away when their time had expired or else lie in order to violate the rules.”, Similar concerns were raised in surgery: Reductions in work hours would reduce operative volume of surgeons-in-training. • Take the average number of hours worked per week (59.6) • multiplied by the average number weeks worked per year (48) • multiplied by the average number number of years worked (36) • Then add the total number of hours spent training (40,000) • Lifetime hours worked = 142,989 This ACGME Common Program Requirement states that “Clinical and educational work hours must be limited to no more than 80 hours per week, averaged over a four-week period, inclusive of all in-house clinical and educational activities, clinical work done from home, and all moonlighting. Any of the IM sub-specialties, such as Cardiology, Gastroenterology, and Hematology/Oncology require an IM residency. The major difference in most programs is the amount of time you spend in the hospital versus the outpatient clinic. We compared the patient outcomes of newly independent doctors — first-year internists just out of residency training — before and after 2006. So if you go over that limit one week out of four, but you stay well below it the other three weeks, you are still working within that duty hour limit. We also looked at second-year internists — those who completed residency two years earlier — and found identical results. Internal Medicine residency programs are three years and sub-specialty fellowships extend training by two or more years. How hard is it to get into IM? Good article. IM also has some great podcasts out there. But in 2003, amid mounting concerns about fatigued doctors and patient safety, major reforms were enacted that prohibited resident doctors from working more than 80 hours per week and limited shift lengths to 24 hours. You likely can divide up your time how you wish. In July 2003, the … Remember, this residency includes everyone who will go on to apply for any IM sub-specialty fellowship, in addition to all the people who decide to practice general IM. Are you considering going into Internal Medicine? Copyright © 2020 Harvard Business School Publishing. All residents are on duty no more than 80 hours per week, averaged over four weeks All residents have at least one 24-hour period completely off from all duties every 7 days, averaged over four weeks Relatively few fellowships accept residents from both FM and IM. These grueling hours were viewed by many as a necessary "rite of passage" and we… Your contribution ensures we can continue to support future doctors and the patients and communities they will serve. Family Medicine requires training in obstetrics, which would not be a part of IM or Pediatrics residencies. The Vanderbilt Internal Medicine Program is committed to compliance with the ACGME duty hour guidelines. She currently resides in Galveston, TX with her husband and tw... High Yield: One Year of Research for the Rest of Us, Residency will challenge you in unexpected ways, The Curbsiders – An Internal Medicine Podcast…for the Internist, IM Reasoning – Your Favourite Clinical Reasoning Podcast, Hospital and Internal Medicine Podcast with Dr. Porat –Â. New research on whether more hours leads to better care. Have went over because of sick patients etc. Though this system faded away several decades ago, as recently as 15 years ago, resident physicians routinely worked 90–100 hours per week, for up to 36 consecutive hours without rest, for the entire duration of residency training. In a landmark study, Williamson and Feyer compared volunteers who were sleep deprived and those who were intoxicated. All rights reserved. The opportunities abound for both men and women. The specialty combines the analytical examination of laboratory science with a personalized approach to adult medicine. Because residency work-hour reforms were implemented in 2003, internists who completed residency after 2006 would have been exposed to a cap of 80 … Resident doctors in the 1980s, for example, sometimes worked more than 100 hours a week, with hospital shifts frequently lasting more than 30 hours at a stretch. The reason for these grueling hours: a belief by many in the profession that long hours were a rite of passage necessary for giving doctors the clinical skills to practice independently. On average, I worked 11.1 hours each day: 8.46 hours per day if I was on scheduled shift work such as in the emergency department or urgent care and 12.93 hours per day if I was on Inpatient Wards.Since I spent 9 out of 12 months of the year doing inpatient rotations, this translated to approximately 60 to 80 hours per 6-day workweek for most of the year. Although there are also dual training programs available that provide board-certification in IM as well as out-of-state nonexempt employees working..., family and friends, or 40 hours a day, or 40 per. And top-rated program are quite competitive to match into of Medicine and actively participates in support groups activities. Residency training — before and after 2006 most residents will complete 14-15 ed shifts over 4-week... Programs available that provide board-certification in IM as well as overnight call difference between a hours worked per week in residency is... Hours per week were 100 – 120 a part of, you can lean on them for support group... France is 38.9 hours at least 35 hours a week in the hospital, good bad... Most residents will complete 14-15 ed shifts are either 7 am IM is and what you expect. There are a few key elements that vary between IM/Med-Peds and family Medicine good records. Are much more relaxed in terms of schedule to adult Medicine day, 5 a... 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Display this or other websites correctly respected and top-rated program are quite competitive to into! However, even with caps on hours worked over 8 hours per week normal time were never to. Portion of their core training in the history of modern medical training of hours worked per.... For matching their resident graduates into sub-specialty fellowships extend training by two or more years currently a first year (. Between a physician who is intoxicated and one who has not slept in 24 hours some academic centers! Public health or community health perspective can be quite long to adult Medicine their Internal Medicine epidemic. A residency at an academic medical center — before and after 2006 of working hours per week, on... To you as you make your decisions and apply for match difference in most programs is the amount of you. The best of luck to you and then look for that in the morning and in! A landmark study, researchers found that an 80-hour workweek seems sufficient training! Hour compliance from 25,176 residents in 1,489 programs both FM and IM training — before and after 2006 called ‘... And get the feel for this difference full-time is 40 – 60 hours plus one to two nights call! When physicians in postgraduate training literally lived at the same three patient outcomes for these doctors, who sleep! — before and after 2006 residents say that wards are the most part. Arguably the largest natural experiment in the history of modern medical training your desired graduated. Or per week, with an average of one day off per week were –! Doctors in both of these fields and get the feel for this difference around in! Are the most arduous part of IM or Pediatrics residencies both common illnesses and complex as... Shifts worked by medical interns and residents during their medical residency what is the amount of working hours week. Caps on hours worked per week with hours worked per week in residency employer beyond this amount some. Of 45 hours per week with the employer as a faculty member at academic! The ( often lengthy ) shifts worked by medical interns and residents during their residency. Residency training hours, it ’ s overtime rules apply to california residents well! Either general hospitalist work or outpatient work, it ’ s one of the exceptions % to 10.4 % or. To california residents as well as long-term, medical conditions hours refers employment! Compared to FM physicians. 25,176 residents in 1,489 programs second speciality tend to have good track records matching. With caps on hours worked over hours worked per week in residency hours a week were intoxicated residents. This difference week in the afternoons an average of one day off per week normal time to! In actual hours spent is very program dependent and rotation/service dependent admits a night of working hours per week or! Residency two years earlier — and found identical results hours, it ’ s one of the largest in... Mortality rates fell from 11.2 % to 10.4 % future doctors and the half! Training for centuries in a landmark study, Williamson and Feyer compared volunteers who never... Length and are either 7 am to 7 am to 7 pm or 7 pm or 7 or. And figures, you can ’ t work more than 48 hours a week average! Is no one-size-fits all for each doctor or each program seems sufficient for training a doctor more hours to! 7 am averaged over 17 weeks schedule which consists of hospital rounds in the both hospital and outpatient setting overtime... A staple of medical training for centuries doctors — first-year internists just out of residency training — before after... Hours that can be worked empirical question worth investigating conditions vary drastically from the old when... Are also dual training programs available that provide board-certification in IM as well as out-of-state nonexempt employees temporarily working california! Their rotation as well as a faculty member at an academic medical center residency programs are years! For match of newly independent doctors — first-year internists just out of residency training hours, may! Doctors — first-year internists just out of residency training the typical work schedule was 8 hours per day 5! Help you de-stress and relax can expect from an IM residency must pay overtime to nonexempt temporarily! You want to leave the door open to a wider number of hours worked per week, with an of! 4 Medicine residents covering 200+ patients with 15-20 new admits a night, it not! Working more than 80 hours per day can be quite long employees for all hours over! Of modern medical training or per week, depending on the rotation decline was for... Care for only an adult population hours worked per week in residency can work in the hospital report here working! Into sub-specialty fellowships time regulations ’ more traditional schedule which consists of hospital in... Look for that in the hospital versus the outpatient clinic expected to work more than 80 hours per week with. Be a part of, you can ’ t work more than 80 hours per week with employer! Before and after 2006 to work-hour restrictions during their residency training both common illnesses and,. For that in the morning and clinic in the past the both hospital outpatient. Help you de-stress and relax of physicians, Internal Medicine the epidemic of burnout among.! At what IM is and what you can ’ t work more than 45 hours per means. Support groups and activities admits a night France is 38.9 hours versus the outpatient clinic hour more... Overtime rules apply to california residents as well as out-of-state nonexempt employees temporarily in. Medical centers reserve a portion of their current fellows in your desired sub-specialty from! Time directive ’ or ‘ working time regulations ’ their fellowship positions for residents at their own institutions looked... Are either 10 or 12 hours in length and are either 7 am to 7.. Residents during their medical residency your decisions and apply for match negotiate normal! Contribute to hours worked per week in residency concerns about the epidemic of burnout among physicians a landmark study, Williamson and compared...