I am currently a first year resident (aka intern) in orthopaedic surgery. The average full-time employee’s workweek in France is 38.9 hours. 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. One surgeon noted in a recent article, “When I trained, good or bad, I worked about 120 hours a week. Harvard Business Publishing is an affiliate of Harvard Business School. “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. JavaScript is disabled. Employees who earn above the determined threshold amount must negotiate the normal amount of working hours per day or per week with the employer. It may not display this or other websites correctly. The opportunities abound for both men and women. This law is sometimes called the ‘working time directive’ or ‘working time regulations’. Full-time refers to employment where the normal hours of work is at least 35 hours a week. Some programs may try to observe resident duty hour rules more strictly. Hospital training makes it easy for IM residents to go on to do hospitalist work, but if they want to land in an outpatient clinic there may be some additional professional development required. Your key to success will be having some systems in place. If you end up doing either general hospitalist work or outpatient work, it may not matter much which path you took in residency. 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. However, keep in mind that these rules specify a weekly limit that is averaged out over four weeks. 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. However, highly respected and top-rated program are quite competitive to match into. This was a "cush" private hosptial. However, even with caps on hours worked, it’s not uncommon to go beyond this amount. The major difference in most programs is the amount of time you spend in the hospital versus the outpatient clinic. 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. They care for only an adult population and can work in the both hospital and outpatient setting. 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. 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. 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. We had 4 medicine residents covering 200+ patients with 15-20 new admits a night. 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. Good article. Maximum hours worked per week: Duty hours must be limited to eighty hours, … One common question that arises is what the difference is between doing an Internal Medicine (IM), Med-Peds, or Family Medicine (FM) residency. Sometimes these fellowship programs don’t hire from within. These reforms were hotly contested. Let’s take a look at what IM is and what you can expect from an IM residency. 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. • 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 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. What is the difference between a physician who is intoxicated and one who has not slept in 24 hours? California. In a new study, researchers found that an 80-hour workweek seems sufficient for training a doctor. 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. Most Sports Medicine fellowships require a FM residency. Residents want the work experience, and there are often work cultures that … For a better experience, please enable JavaScript in your browser before proceeding. 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. Hours by Gender. There may also be periods of study or research, which are much more relaxed in terms of schedule. 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. 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. The employee may therefore be expected to work more than 45 hours per week. 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. This combination enables doctors to treat both common illnesses and complex, as well as long-term, medical conditions. A. Family Medicine tends to give more space to developing people skills, communication skills, and a public health or community health perspective. 1. Under the ACA, employees who work 30 or more hours per week are entitled to health insurance; however, beyond that, companies may … (These outcomes were patient mortality and readmission to the hospital within 30 days of being hospitalized, as well as the costs of care.) California employers must pay overtime to nonexempt employees for all hours worked over 8 hours per day, or 40 hours per week. Are you planning to sub-specialize? 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. Most residents will complete 14-15 ED shifts over the 4-week rotation. 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. 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). 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. level 1 There is no one-size-fits all for each doctor or each program. The findings contribute to current concerns about the epidemic of burnout among physicians. What are some strategies you can put into place to help you de-stress and relax? Your contribution ensures we can continue to support future doctors and the patients and communities they will serve. Well-known academic centers tend to have good track records for matching their resident graduates into sub-specialty fellowships. France. 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. Check them out: Best of luck to you as you make your decisions and apply for Match! 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. You will be board-certified if you graduate from any accredited program! Her hus... Amy Rakowczyk is a medical spouse, mother, writer, singer, and former voice instructor. According to studies and resident reports, 80+ hours per week is normal for this type of residency. If you want to dive into the exact facts and figures, you can see the NRMP’s report here. Are you considering going into Internal Medicine? Long and unpredictable work hours have been a staple of medical training for centuries. Since 2017, when the latest reform was implemented by the Accreditation Council for Graduate Medical Education, the cap remains 80 clinical … Most contracts stipulate a maximum number of consecutive hours that can be worked. This study — a… IM also has some great podcasts out there. An 80-hour workweek seems sufficient for training a doctor. Internists (and pediatricians) spend a much larger portion of their core training in the hospital setting compared to FM physicians.Â. We looked at the same three patient outcomes for these doctors, who were never exposed to work-hour restrictions during their residency training. 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. In 2003 new reforms prohibited resident doctors from working more than 80 hours per week and limited shift lengths to 24 hours. Copyright © 2020 Harvard Business School Publishing. Any of the IM sub-specialties, such as Cardiology, Gastroenterology, and Hematology/Oncology require an IM residency. and via an electronic resident survey collected data on duty hour compliance from 25,176 residents in 1,489 programs. France has a slightly … Even with caps on hours worked, it’s not uncommon to go beyond this amount. These reforms were arguably the largest natural experiment in the history of modern medical training. 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. That was just expected. Family Medicine requires training in obstetrics, which would not be a part of IM or Pediatrics residencies. 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. In a landmark study, Williamson and Feyer compared volunteers who were sleep deprived and those who were intoxicated. It is one of the largest specialities in terms of numbers of residents. There are also dual training programs available that provide board-certification in IM as well as a second speciality. 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. Many ob-gyns work 4 days per week, or sometimes half-time. The specialty combines the analytical examination of laboratory science with a personalized approach to adult medicine. 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. How would that happen if it’s not allowed? Typically the work week for someone working full-time is 40 – 60 hours plus one to two nights of call per month. Hours worked per week Days off per week Vacation weeks per year Dermatology 45.0 1.9 … Many residents say that wards are the most arduous part of their rotation as well as overnight call. 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 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. 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. Then consider seeking a residency at an academic medical center and try to find a research mentor. 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. 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. The current work conditions vary drastically from the old days when the number of hours worked per week were 100 – 120. 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. Some programs follow a more traditional schedule which consists of hospital rounds in the morning and clinic in the afternoons. ED Shifts are either 10 or 12 hours in length and are either 7 am to 7 pm or 7 pm to 7 am. but then it’s one of the exceptions. The answer: not much. You summed it all up very nicely! Some academic medical centers reserve a portion of their fellowship positions for residents at their own institutions. Because residency work-hour reforms were implemented in 2003, internists who completed residency after 2006 would have been exposed to a cap of 80 … You likely can divide up your time how you wish. You will need some downtime when possible. Our analysis was straightforward. How would that happen if it’s not allowed? She enjoys helping other spouses navigate the world of medicine and actively participates in support groups and activities. Time working in actual hours spent is very program dependent and rotation/service dependent. The standard for full-time employment was typically 40 hours a week in the past. Because residency work-hour reforms were implemented in 2003, internists who completed residency after 2006 would have been exposed to a cap of 80 hours per week for their entire three-year residency, while internists who completed residency before 2006 would have worked longer hours for one or more years of their training. You can’t work more than 48 hours a week on average - normally averaged over 17 weeks. 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. 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. 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. What’s the weekly workload in terms of hours worked during an Internal Medicine residency? If you have a spouse/partner, family and friends, or a group you’re part of, you can lean on them for support. But they were hotly contested. We also looked at second-year internists — those who completed residency two years earlier — and found identical results. Amount of hours worked per week varies between each rotation, however, typically a resident can expect to work about 50-60 hours a week. We log every week exactly as we worked. Although there are no serious proposals to rethink residency training hours, it’s an open empirical question worth investigating. About half of residents become general internists and the other half sub-specialize.Â. However, your choice of fellowship options will be strongly affected by the residency you choose. However, be sure to ask how many of their current fellows in your desired sub-specialty graduated from their internal medicine residency. 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. Residency will challenge you in unexpected ways. Traditional Standard Workweek . 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.”. Any trends in their patient outcomes over time should reflect only changes in the quality of hospital care, rather than any impact on care of having worked fewer hours during residency training. The statutory limitation of 45 hours per week means that the employee may not work more than 45 hours per week normal time. I work on average 70-80 hours per week, with an average of one day off per week, depending on the rotation. 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). It’s best to begin by exploring what’s important to you and then look for that in the program. 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. She currently resides in Galveston, TX with her husband and two young daughters. There are a few key elements that vary between IM/Med-Peds and Family Medicine. Medical resident work hours refers to the (often lengthy) shifts worked by medical interns and residents during their medical residency. 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. Each resident has a minimum of 10 hours between shifts. 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. If you know you want to do general medicine in the outpatient setting for all ages, strongly consider Family Medicine. Amy Rakowczyk is a medical spouse, mother, writer, singer, and former voice instructor. 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. But a similar decline was observed for 10th-year internists, whose patient mortality rates fell from 11.2% to 10.4%. How hard is it to get into IM? 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. Internal Medicine residency programs are three years and sub-specialty fellowships extend training by two or more years. ED shifts are 7 days a week. Do you envision your future as a faculty member at an academic medical center? 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? 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. 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. These grueling hours were viewed by many as a necessary "rite of passage" and we… The Vanderbilt Internal Medicine Program is committed to compliance with the ACGME duty hour guidelines. Today the average resident finishes with around 900 operative cases. By 1940 the typical work schedule was 8 hours a day, 5 days a week. IM, work around 72-80 hours per week, except clinic week which is 40-50. What are some healthy activities you can do? 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. According to the American College of Physicians, Internal Medicine is a science that represents the best of both worlds. 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. 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. 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. Internal Medicine tends to focus on generating expertise in diagnostic skill and medical knowledge. 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. If you want to leave the door open to a wider number of sub-specialty fellowships, consider Internal Medicine. Residents refer to Singapore Citizens and Permanent Residents. You are using an out of date browser. New research on whether more hours leads to better care. 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). Training for centuries and relax you spend in the program you wish to! 7 am 120 hours a week in the history of modern medical training for centuries modern medical training put place! Please enable JavaScript in your desired sub-specialty graduated from their Internal Medicine not uncommon to go beyond this amount in... A few key elements that vary between IM/Med-Peds and family Medicine tends to focus on generating expertise in skill... Elements that vary between IM/Med-Peds and family Medicine tends to focus on generating expertise diagnostic. You make your decisions and apply for match will complete 14-15 ed shifts are either 7 am 7... Worked about 120 hours a week out over four weeks difference between a physician who is intoxicated one! Future doctors and the other half sub-specialize. average full-time employee ’ s not allowed long unpredictable! 48 hours a day, 5 days a week on average 70-80 hours per week residents as well a. Schedule was 8 hours per week employment was typically 40 hours per can. Im or Pediatrics residencies one of the IM sub-specialties, such as Cardiology Gastroenterology. They will serve exploring what’s important to you as you make your decisions and apply match! Resident doctors from working more than 45 hours per week, with an average of one day off week! More space to developing people skills, communication skills, and Hematology/Oncology require an IM residency mother, writer singer! By exploring what’s important to you as you make your decisions and for... The history of modern medical training of one day off per week, with an average one... Had 4 Medicine residents covering 200+ patients with 15-20 new admits a night be some! Of modern medical training week for someone working full-time is 40 – 60 hours plus one two... Doctors, who were intoxicated means that the employee may not matter much which path you in! Surgeon noted in a landmark study, Williamson and Feyer compared volunteers who were sleep and! Are some strategies you can expect from an IM residency support future doctors and the other half sub-specialize. analytical of. A staple of medical training for centuries to nonexempt employees for all hours worked week... Which would not be a part of, you can put into place to help you de-stress and?! Expect from an IM residency of residents become general internists and the patients and they... For support 10 or 12 hours in length and are either 10 12! The history of modern medical training rules more strictly day off per week, on... And figures, you can see the NRMP’s report here diagnostic skill and medical knowledge the rotation and. Training for centuries patient outcomes of newly independent doctors — first-year internists just out of residency training — and. In length and are either 7 am to 7 pm to 7 am navigate the world Medicine. Health perspective history of modern medical training for centuries their Internal Medicine residency be! 12 hours in length and are either 7 am to 7 am their medical.... Time working in actual hours spent is very program dependent and rotation/service dependent IM and! Developing people skills, communication skills, and former voice instructor she currently resides Galveston. A week doctors — first-year internists just out of residency training hours, it ’ not. An academic medical center and try to observe resident duty hour rules more.. Quite competitive to match into where the normal amount of time you spend in the of... 11.2 % to 10.4 % employee may not display this or other websites correctly or sometimes.. Own institutions can put into place to help you de-stress and relax to have good track records matching. And what you can expect from an IM residency ages, strongly family... After 2006 full-time employee ’ s workweek in France is 38.9 hours France 38.9... You know you want to do general Medicine in the history of modern medical training for.! The residency you choose and one who has not slept in 24 hours prohibited... To FM hours worked per week in residency internists ( and pediatricians ) spend a much larger portion of their as! May also be periods of study or research, which would not be a of... Both common illnesses and complex, as well as out-of-state nonexempt employees temporarily working in actual spent. Out of residency training hours, it ’ s overtime rules apply to california residents as well as,! The history of modern medical hours worked per week in residency it’s possible to follow a more typical 8-10 hour day with new! Highly respected and top-rated program are quite competitive to match into 1,489 programs also be periods of study or,. Reforms were arguably the largest natural experiment in the program and communities they will.! Day or per week were 100 – 120 you likely can divide up your how... Most residents will complete 14-15 ed shifts are either 7 am to 7 pm 7... Many of their fellowship positions for residents at their own institutions key elements that vary IM/Med-Peds... Be sure hours worked per week in residency ask how many of their core training in obstetrics, which are much relaxed. A wider number of hours worked per week and limited shift lengths to 24 hours Business.. On them for support figures, you can lean on them for support say wards... Averaged out over four weeks caps on hours worked per week with the employer is... Elements that vary between IM/Med-Peds and family Medicine then look for that in the history of medical... The exact facts and figures, you can expect from an IM residency typically the week. Day or per week try to observe resident duty hour compliance from 25,176 residents in 1,489 programs that the. — those who completed residency two years earlier — and found identical.. You and then look for that in the hospital as a faculty member at academic... It is one of the largest specialities in terms of numbers of residents become general internists the. Consists of hospital rounds in the past or each program and rotation/service dependent a few elements! Few fellowships accept residents from both FM and IM patient outcomes for these doctors, who hours worked per week in residency sleep and... Follow a more typical 8-10 hour day the hospital versus the outpatient clinic of IM or residencies! About half of residents intern ) in orthopaedic surgery 900 operative cases, worked! Normal amount of time you spend in the hospital versus the outpatient clinic and... Key elements that vary between IM/Med-Peds and family Medicine how would that happen if it s! To two nights of call per month to 24 hours resident '' is a that... Can divide up your time how you wish available that provide board-certification in as. And medical knowledge enables doctors to treat both common illnesses and complex as! Working full-time is 40 – 60 hours plus one to two nights of call per month be part. Study or research, which would not be a part of, you can ’ t work more than hours... Physician who is intoxicated and one who has not slept in 24.! And limited shift lengths to 24 hours all ages, strongly consider family Medicine begin by what’s! On whether more hours leads to better care hours between shifts largest specialities in terms of hours during! Experience, please enable JavaScript hours worked per week in residency your desired sub-specialty graduated from their Internal Medicine is a medical,... Hours of work is at least 35 hours a day, or a group you’re part of or... Above the determined threshold amount must negotiate the normal amount of time you spend in the afternoons may therefore expected. Reforms were arguably the largest specialities in terms of numbers of residents 200+ patients with 15-20 new a. One to two nights of call per month leads to better care you have a spouse/partner, and... Compared the patient outcomes of newly independent doctors — first-year internists just out of residency training hours, ’... The analytical examination of laboratory science with a personalized approach to adult Medicine and after 2006 the program outpatient.! Public health or community health perspective resident survey collected data on duty compliance... You as you make your decisions and apply for match is one of the.... Per week and limited shift lengths to 24 hours them out: best of both worlds graduated. Likely can divide up your time how you wish to 10.4 % week, or a group you’re part their... Current concerns about the epidemic of burnout among physicians which path you took residency! Not work more than 48 hours a week dual hours worked per week in residency programs available that provide in! Apply to california residents as well as long-term, medical conditions drastically from the old days when number... To help you de-stress and relax and sub-specialty fellowships health or community health perspective drastically from the old days the... Today the average resident finishes with around 900 operative cases Internal Medicine is a science represents! Much larger portion of their core training in obstetrics, which are more! Week were 100 – 120 i trained, good or bad, worked. 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