Doctors and work hours

My dad sent me two articles that he thought I’d find interesting in light of the ongoing discussion here about work hours.

The first is an article on The Relationship between Specialty Choice and Gender of US Medical Students, 1990-2003.  It debunks the idea that the increase in the fraction of doctors who are women is responsible for the decreasing interest of medical students in specialties where hours are considered "uncontrollable," especially internal and family medicine, pediatrics, ob/gyn and general surgery.  In fact, in every time period examined, women were more likely than men to be planning on uncontrollable specialties.

The second is an article from the Johns Hopkins Medical School alumni magazine about the changes involved in implementing the 80-hour/week restrictions on interns’ and residents’ working hours.  On the one hand, it’s a little surreal to read about a world in which 80-hour work weeks are considered virtually part-time.  But, it’s also a story about a place where people swore that it was impossible to limit working hours without destroying the experience, until they didn’t have a choice, and then they managed to do it.  And if law firms and game companies suddenly faced economic disincentives to working people huge hours (instead of strong incentives to do so), they’d change as well.

7 Responses to “Doctors and work hours”

  1. Jennifer Says:

    The John Hopkins’ article is fascinating (if you close your eyes every time 80 hours or 110! hours a week of work is mentioned).
    I’m rapidly coming to the conclusion that at least in an office job, the difficulty comes if people want to do different hours. It doesn’t much matter what they are. An office will work pretty well if everyone works 30, 40, 60, or 80 hours. But as soon as you have some working 20, and others working 60, it starts being very difficult to manage.
    I’ve been wondering ever since your first (or at least early) post on this how many hours Lincoln’s Chief of Staff worked. Was it the 100 hours a week it is now?

  2. landismom Says:

    I’ve recently been reading a textbook called “Understanding Health Policy” that has me thinking about all the ways our health care delivery system could be different, including reducing by far the number of specialty physicians and increasing the number of general practitioners, the way it is in the U.K. I wonder what the gender division is among docs in the National Health System?

  3. Phantom Scribbler Says:

    What makes the discussion of the workload of interns and residents different from most other workload issues is the number of hours they are supposed to work *in a row*. Twelve-hour days at a game company are one thing. But, before protective regulations were in place, interns and residents were expected to make life-and-death decisions at the tail end of a thirty-six hour shift — that is thirty-six hours without sleep. As it is, the new regulations that the Johns Hopkins article bemoans allow for thirty-hour shifts. They may talk about “experience” and “learning,” but it sounds more like a hazing process to me, and one that offers dubious benefits to patients.

  4. Mieke Says:

    One of my best friends is in the first year of her psychiatry residency now. She’s the mother of a one year old and two year old. She’s 34 and impressive in every way. She has four more years to go at this breakneck speed. I don’t know how she does it and yet she does. She’s an attentive and caring mother who just happens to be away every fifth day. At this age the kids don’t notice that much who’s taking them to the park as long as they are going.
    She’s exhausted a lot but loves what she does and would not give it up. She chose pediatric psychiatry despite the added year of schooling so she would have the flexibility in her schedule to do the mommy things she wants to do when she’s done. She’ll have office hours which she can control and plans on working primarily during school hours and rounds for the rare child who is admitted. It’s a big pay out in time now with some sacrifices but in the end – she’ll have the life she wants with her kids.
    Also all the ob/gyns in the practice that delivered my sons work part-time. ALL OF THEM!

  5. Mieke Says:

    I guess it goes without saying that it’s an all women ob/gyn practice.

  6. Christine Says:

    Having worked in the healthcare for a short period of time and family members who are nurses and physians, I can say from personal experience and observation that medical students turn away from specialties not only for hours, but due to malpractice insurance. It is an obscene amount to carry. Reducing hours for residents and fellows will not prepare them for the excessive hours of private practice. This is a field that requires acute attention at possibly high levels of exhaustion. Everyone wants a rested physician (keeping in mind that there are professionals surrounding physicians that are more rested), but aren’t there other occupations and industries that require the same excess style of working hours – military, parenting, etc. I am not advocating excessive hours for medical professions, but when a patient goes into labor an OBGYN has to deliver, whether exhausted or rested. I am not sure if reducing the number of specialists would be effective in such a specialized medical society in which we live. Most people want the most educated and specialized physician, not a PA or NP. That is why socialized medicine has many foes. As long as a general practitioner can pass every specialized board certification exam (which I find highly improbable) then he or she should be allowed to practice in those specialty areas of medicine.

  7. amy Says:

    Mad macho hours is one reason I no longer allow residents anywhere near me for any serious procedures, and why I made a big ugly scene about it when I went to have my kid (in August, shortly after the new first-year residents arrive). Doing my bit for medical education does not include putting myself in the hands of the mildly hallucinating & inexperienced. They’re nice people, inordinately nice given the conditions they work under, and at this point I’ve known some of them since they were undergrads, know they’re smart, responsible, etc. Even so. Forget it.
    The thing about the 80h/wk regs is that they aren’t really 80h/wk; they’re 240h/4wks. The hospitals can work that as they please.
    Landismom, there’s something of a GP crisis in the US, partly because it doesn’t pay as well as specialties. It’s important because people often walk out of med school with $100K+ in student loans, reimbursements are often a problem, and malpractice insurance doesn’t stop going up. Unless you’re using a small individual-practice model, the number of patients you have to see in a day as a GP just to break even is staggering, esp. since many of them may be Medicare/Medicaid patients and may represent a net loss.
    I am not sure less specialization is really a fine answer anyway once you get away from very common illnesses. The scope for mistakes due to relatively-rare-illness is tremendous. My sleep-apneic husband was recommended for ECT with a misdiagnosis of severe depression at our GP clinic; I was misdiagnosed with conjunctivitis (instead of blepharitis) at the clinic last summer, wanderered around with runny infected eyes for a month before saying ‘oh screw this’ and going to the specialist. On follow-up with the specialist, a retina guy, I was told I had bizarre conjunctival scarring and sent to a cornea guy, who said no, it’s normal, old, and unimportant. (A second cornea guy confirmed.)
    I’m trying to think how many GP residents I saw who missed my pneumonia. Wandered around with that one for nearly two months before landing in the ER. And then went to a specialist, who treated it properly.

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