Surgical Residency Study

[Chrisada]

But the thing is I know so many women not married to doctors whose husbands are away just as much or more. One friend has lived away from her husband for over a year and her and the kids see him maybe on the weekend. Another friend's DH travels out of the country for weeks at a time. The finance and lawyer husbands are always working too. My FIL is always traveling, leaving his little ones behind. It just seems to me that alot of fairly successful men work a lot of hours away from their families, at least in my circle. We seem to have an American culture in general of working a lot.

[MissCrabette]

Ha! I'm not touching the work hour restriction topic.

I see your point and totally agree about the need for some life experience before medical school, but... pretty much the entire rest of the world has high schoolers go straight to medical school, and I can't say that they're worse doctors because of it.

[Pollyanna]

But the thing is I know so many women not married to doctors whose husbands are away just as much or more. One friend has lived away from her husband for over a year and her and the kids see him maybe on the weekend. Another friend's DH travels out of the country for weeks at a time. The finance and lawyer husbands are always working too. My FIL is always traveling, leaving his little ones behind. It just seems to me that alot of fairly successful men work a lot of hours away from their families, at least in my circle. We seem to have an American culture in general of working a lot.

Exactly this. I don't have a single friend who's husband works "bankers hours". Even my friend who's husband is a banker, he travels, has tons of late meetings and community interactions that are required. Other friends husbands travel Sunday night to Friday night. Others who are in the military. Not a single one of those wives complain that their hubby's jobs are too demanding or that they should be home more. Honestly they are happy that they have a job. I don't know, I guess it's normal to me. I don't know any different, my grandmother worked in a sweat shop to support her boys, my folks worked 12 hour days 7 days/week up until my dad got sick. All my relatives work similar hours in different fields.

[PrincessFiona]

Exactly this. I don't have a single friend who's husband works "bankers hours". Even my friend who's husband is a banker, he travels, has tons of late meetings and community interactions that are required. Other friends husbands travel Sunday night to Friday night. Others who are in the military. Not a single one of those wives complain that their hubby's jobs are too demanding or that they should be home more. Honestly they are happy that they have a job. I don't know, I guess it's normal to me. I don't know any different, my grandmother worked in a sweat shop to support her boys, my folks worked 12 hour days 7 days/week up until my dad got sick. All my relatives work similar hours in different fields.

Raising eyebrows ....

Personally, I wouldn't advocate a family life for anyone where the husband or wife is away from home that frequently. Call me an old fuddy-duddy, but I feel strongly about the fact that our children deserve better ... and so do we. So what if the finance and lawyer husbands work themselves to death and don't make time for their children. Bad on them!

We have Mayo trained surgeons here who gave up that life for something quieter when they realized that they were "missing it all". They are great surgeons and pretty neat people. Their lives are about their patients and their families. One in particular coaches his son's soccer. He used to be on Faculty at Mayo as an FYI.

I look at my children now and wonder how life could have been different for them if dh hadn't been working 100-120 hours a week for years on end. Yes, they have special needs, but were we really doing a good job of meeting those needs when I was parenting for two, and he was never available as the father figure in their lives? No. Our lives look so much different today, and as much as I sometimes complain about where we live, if I had to make this choice over again, I would. My husband has TIME for our marriage and for our kids. Could I still do the whole single parenting thing and do a pretty ok job? Yes. I'm sure that I could. I'm so glad that I don't have to. I love that dh takes Zoe to dance every Wed. and then to McDonalds for dinner. I love that he can actually make it to the orchestra concerts and soccer games more than just occasionally.

Why get married and have a family if at the end of the day, all you do is work and not see them?

I have experienced the medical training process up close and personal in two different countries, and I can tell you that we here in the US also just "cook with water"....nothing magical about medicine in America.

You can have an excellent surgeon and outcome in Germany...you can get the latest cancer treatments available without having to jump through the hoops like here in the US ....

Just because our culture values work above children, personal health and marriage doesn't make it right.

I ask my kids "if everyone was jumping off of a cliff, would you" when we talk about peer pressure and big issues, like drinking or drugs. Hell no, they wouldn't. So .... since everyone (at least everyone we know) is working at the expense of their personal health and well-being and that of their family, should you do it too?

Kris

ETA: I have plenty of friends whose husbands work much lighter hours. They are teachers, nurses (believe it or not), managers of companies and ... actually yes, bankers LOL. NO one is also suggesting that physicians work 9-5.

[mommax3]

DH is q2 M-Th every week and has been for the past 7 years. He is on every 4th weekend b/c he and his partner share weekend call with another group of two. The week he has call on the weekend, he is on MWFSaSu, off the following Monday, and back on call on Tuesday. When DH or his partner takes vacation, it is all on the other guy.

Now, as a two man group, they don't get slammed on call (usually), so it is doable. In a bigger group, the patient load would be greater and there would be no way you would expect to get any sleep on call nights, although call would be less frequent. Even his weekend calls (covering for 4) are considerably busier. He recently told me that he is glad they have a third partner starting this summer because he doesn't feel like he can do a week alone anymore. This has been a long time coming....he will be 42 in September.

I have known DH since he was 10 and he has *never* needed much sleep....his mom says it has been true of him since he was an infant. I truly do think he is one of those rare people who can get by on 5 or 6 hours a night. When we are on vacation, he doesn't sleep any more than that.

Something to think about....(and I am only familiar with DH's specialty)....if docs work less/take less call/have bigger practices and see fewer patients, their compensation will go down. DH makes more than the average for OB, and part of that has been because he and his partner wanted to keep volume high so that a third partner could start and be busy right away, but we aren't millionaires by any stretch. If he made more "lifestyle" choices in his practice model, but also made less $$$, the call and length of training would very quickly not be worth it.

[PrincessFiona]

True, Sally ... perhaps addressing the cost of medical school could factor into this theoretical discussion. At the end of the day though, working less does mean less $ in any profession. I guess it's important to weigh what values are important to each individual.

[Pollyanna]

So .... since everyone (at least everyone we know) is working at the expense of their personal health and well-being and that of their family, should you do it too?

Kris

I guess I don't see them as mutually exclusive. My father never once complained about having a poor relationship with his father (who was an immigrant shoe maker that worked late every night). He only talked about how his father made time to be a great husband and dad even though he had to work so hard. It never dawned on me to complain that my folks worked every weekend and I don't think we have less of a family because of it, and it sure as hell didn't hurt their marriage. This is just my perspective and $0.02.

[mommax3]

To add to my previous post.....most of our friends (doctors, home builders, manager at a transmission plant, pastor, state trooper, pilot) are not 9-5 employees, but still work less hours than DH, and I do get jealous that other dads are able to coach soccer or pick up the kids from various activities, etc., or just be available if Their wives want to do something in the evening (book club, exercise class, etc.) DH is able to make it to the "big stuff" If he knows about it in time to schedule around it, but the nature of his practice (surgical in part) and the call it entails means that I never know when he is coming home.....and I really don't see a way around that, even if training were lengthened.

[PrincessFiona]

Tara I think that you are making an interesting point but The world is a different place. It is great that your father was not negatively impacted. I'm sure it gave him a great work ethic. At the same time expectations were very different for mothers and fathers back then. It was even much different when we were children. My parents were not expected to be responsible for my homework. They did not have to drive me to activities every day. Expectations of children and parents have increased greatly. If 1 parent is always missing in action that means the other parents have to do everything. That is really not possible today. Besides that I want my children to have a good relationship with their father that means to me that they see him.

As an aside my husbands productivity is quite high because of how he organizes his practice. He works roughly 60 hours a week and can be somewhat flexible scheduling.

[PrincessFiona]

My husband's emotional health and ability to cope has improved greatly since the end of residency and fellowship.

My father never once complained about having a poor relationship with his father (who was an immigrant shoe maker that worked late every night). He only talked about how his father made time to be a great husband and dad even though he had to work so hard.

The irony here is that the immigrant shoe maker types probably took what little work was available to them and then worked themselves to the bone so that their children could grow up and have better. They were working for their families. Docs, on the other hand...

[PrincessFiona]

+1 littlebitcrunchy

Ill step back a bit. Ironically, my lack of sleep has made me way too bitchy today.

[ladymoreta]

It never dawned on me to complain that my folks worked every weekend and I don't think we have less of a family because of it, and it sure as hell didn't hurt their marriage. This is just my perspective and $0.02.

While I never complained, of course, I missed them. I am jealous of people who are close to their moms and dads. Quality time is important, but I think we lacked so much quantity, and I have a private personality, so we just never quite got there, you know.

While I know doctors will never have 40-hour workweeks, this article gives some great info about what we're doing by having them work much longer: http://www.alternet.org/visions/1545...y/?page=entire

The Business Roundtable study found that after just eight 60-hour weeks, the fall-off in productivity is so marked that the average team would have actually gotten just as much done and been better off if they’d just stuck to a 40-hour week all along. And at 70- or 80-hour weeks, the fall-off happens even faster: at 80 hours, the break-even point is reached in just three weeks.

And finally: these death marches take a longer-term productivity toll as well. Once the crisis has passed and that 60-hour-a-week team gets to go back to its regular 40, it can take several more weeks before the burnout begins to lift enough for them to resume their typical productivity level. So, for a while, you’ll get significantly less than a full 40 out of them.

That study was for production workers. They found that knowledge workers had even less productivity as hours increased. Also,

The other thing about knowledge workers is that they’re exquisitely sensitive to even minor sleep loss. Research by the US military has shown that losing just one hour of sleep per night for a week will cause a level of cognitive degradation equivalent to a .10 blood alcohol level. Worse: most people who’ve fallen into this state typically have no idea of just how impaired they are. It’s only when you look at the dramatically lower quality of their output that it shows up.

[Cinderella]

I believe so. I truly believe any doctor - resident or attending - who is working on inadequate sleep is putting patients in danger.

I think they should eliminate undergrad requirements, let people go straight into medical school (which may need to be extended one or two semesters or offer summer classes), and extend residency for those who wouldn't get enough experience under safe work hour restrictions. The total number of years in school wouldn't change much, but they would have more experience doing their specialty.

This is what they do in Ireland. Your major, what ever it is is chosen when you are accepted to university. I.e you apply to a college & a field of study from high school. The results of testing & entrance are then published in the newspaper. If in medicine you have more years but its less than eight - I think maybe six.

Ha! I'm not touching the work hour restriction topic.

I see your point and totally agree about the need for some life experience before medical school, but... pretty much the entire rest of the world has high schoolers go straight to medical school, and I can't say that they're worse doctors because of it.

Along the lines of this thread of thought about going into medical school straight out of high school. I know in Egypt they go straight from high school into medical school. At the age of 14-15 there is a national aptitude test that sorts them into their high schools. The ones that are good in the maths and sciences basically have their entire high school centered around that. It's sort of like doing or Under Grad in college but at the high school level. Then the ones in the science high schools either go straight into engineering, dentistry or medicine at the University level.

I believe they also do this in Norway from the way it was explain to me. When I was there I recall the red, yellow and blue jumpers they wore for their high school graduation and it was explained to me they do a similar aptitude test in their teens to be sorted into the different high schools. Each color represents the school they went to and they graduate in those colors. I believe yellow was for economics, blue was science and red was for liberal arts. I can't say for how it is in the rest of the world but from my understanding something similar is also done throughout Europe.

When I first learned about this many years ago I feel like High School is a big joke here. Especially knowing you can test out of high school in the US by getting a GED and go straight to a public university or community college in most cases. Some people need more time to mature but perhaps there is too much idle time for the youth in America today. Not everyone is having opportunities to do extra curricular activities outside of school and are more fulfilled by what they do in class than outside.

I have to wonder if we gave similar aptitude tests for our teens and sort them in high school to train them in a career earlier perhaps there would be more satisfaction? Plus wouldn't it be good if they would be among like peers? Wouldn't it also be more efficient with our educational system instead of repeating similar course material and eventually wouldn't that reduce cost? A lot of classes I took in high school I felt I just repeated in my Under Grad and were a waste of time and effort even if the prof said we were expanding upon prior knowledge. I know in some cases you can get college credit for classes in high school. Education is going to have to change here eventually I think. CSU announced today that for the first time ever they are cancelling Spring admissions for the freshmen class next year due to the budget cuts in California. That's huge but they just can't afford it. They've had to raise tuition and fees 70% in the span of five years which is much higher than the national average. I just think about all those future pre-med students and how this whole system is affecting everyone.

[niener]

I have so many thoughts swirling around in my head based on this discussion that I can't get a good handle on all of them. I don't ever expect doctors to have 40 hour workweeks but it seems like the supply and demand problem is getting worse as our population grows and ages. Compounding on that, the process of becoming a doctor and practicing medicine seems to be severely lacking in efficiency. I've watched DH put in orders and take completely irrelevant consults and write discharge summaries and be paged for the most inane things and thought, if there were just a better system in place this would take half the time. And while compensation may be higher than in other fields, for a lot of doctors (if not most) it's still not enough. Family medicine, pediatrics, internal medicine, I can envision a near future in which those fields become all but devoid of MDs and are taken over by NPs/FNPs as everyone flocks to subspecialties. And in a lot of situations (as evidenced by many members here), the spouse works fewer hours or stays home with the family more than he/she would otherwise because of the MD spouse's unavailability. So instead of having two parents who work 40 hrs/wk you have one that works 80; both situations have pluses and minuses.

How this will work out for my family is yet to be seen. Right now, with just the two of us, it's more than fine. With kids, I don't know. I know it will be hard on all of us that dad is not around as much as we want him to be but at the same time, his job enables me to be around for our kids much more than my mother was around for me.