by Conor Friedersdorf

A reader writes:

I think that the most common misconception for my job is that we actually do routinely work 80 hours a week. Doctors in training are one of the few professions, along with truck drivers and pilots where we are defined by a maximum number of hours to work. The way it is defined now is that we can work no longer that 30 hours in one shift, must have 10 hours off between shifts, and must have one day off in 7 when averaged over 4 weeks. You do the math and that makes 80 hours. The 30 hours shifts are what we deem Call and typically have 2 a week. The average over 4 weeks means that often we sometimes work 90 hours and sometimes work about 70.

Clearly this is an arduous task and means that many times people in the hospital are cared for by overworked, exhausted trainees. It also means that we are getting intense training at being able to manage extremely complex patients under significant mental duress. In MANY teaching hospitals there is no staff physician in the hospital at night so even in Intensive Care Units the resident (typically an upper level like myself) is the most experienced person in the building.

All of that said, most of us who have been through this would only go to a teaching type hospital because these are hospitals that typically have 4-6 resident on call physically in the building to see and evaluate patients. If you have ever been to one of the typical small private hospitals the only physician in the hospital may be the ER doctor who is already overworked with the 20 to 30 people in the ED and only see the admitted patients if a Code Blue takes place. Thus all other calls go to the doctor who is at home asleep and has badgered the nurses into not calling him anymore.
So despite the fact that we are tired, cranky, and not completed in our training, I submit that you are much safer being taken care of by the resident who hasn't slept yet then the experienced guy sleeping 30 minutes away from you.

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