I hope this doesn’t sound too ignorant, but I was hoping to find out if the majority of docs work 80+ hours a week (after res). I’m trying to decide if I want to try for med school. This is a big decision for me since I would be quiting a good paying job and spending less time with my husband and kids during at least med school and res. I’m particularly curious about peds and family practice, I’m leaning in that direction. Any thoughts from you guys would be greatly appreciated!
I guess it really depends on the specialty. While I definitely believe that it is greater than 40 hours a week, I don’t think that once you are finished with your residence you are working greater than 80 unless you are a workaholic.
Also, some residency programs are making changes so that working 80+ hours are becoming something of the past. The other thing is that you are so busy during your residency that time probably gets away from you and before you know it, hours have passed by.
Some interesting documentation on the subject-- here are the rules for residency hours, acc. to the Accreditation Council for Graduate Medical Education. In New York State, the guidelines are not only accreditation matters, but they are state law.
The ACGME guidelines limit resident physicians to 80 duty hours per week, averaged over a four-week period, including all in-house call activities. Continuous, on-site duty (including in-house call) cannot exceed 24 consecutive hours and a minimum of 10 hours of rest between duty periods is required. Furthermore, residents must also have 1/7 days free from all educational and clinical responsibilities, averaged over a 4-week period.
An excellent article in “New York” in which older doctors bitch and moan that 80 hours a week is not nearly enough to educate us :
- Once you’re done with residency you can structure your time in many different ways.
- In residency, time demands vary greatly. In my medicine residency program, one month’s average reported work hours were just above 60/week. This means that some people were working 80, a few probably 90, a bunch 50-70, and some 40–because of varying demands of different rotation. (Your mileage will vary: a surgical program would likely not have as many months where the workload was decreased, so your average would be higher.)
As for the “good old days” of following all your patients all the time:
- Patients were on average lower acuity and stayed in the hospital for shorter amounts of time.
- Many patients who were ICU-level patients or dying patients then are normal floor patients now.
- The kind of patients who sat on floors then are in rehab facilities or at home now.
- For all of these reasons, the complexity of interventions, the danger of mistakes, and the speed at which interventions must be carried out without mistakes, has on average increased. And the amount of sleep or slow times one can get while on call has decreased. In my recent medical ICU rotation, overnights with two or three hours of sleep were luxurious. More common was the situation of last night, with 20 minutes sleep. Older doctors pat themselves on the back by talking about getting constantly woken up by pages from nurses. Poor babies. Woken up? What the f were you people doing, sleeping? Freakin slackers.
That means that, in many fields (at least those with a big proportion of inpatient time in large tertiary care hospitals) the 80 hours one works are quite demanding and the decisions are–on average–more critical to get right the first time.
It also means that handoff issues–as discussed in the article–can be a really dangerous part of work hour limitations. But so can fatigue.
I understand why surgeons in particular get frustrated with these rules. I always appreciate when good surgeons are devoted to good follow-up and patient care–it’s one thing I really love about the more old-fashioned surgical ethos. But I’m not sure I buy that work hour regulations are to blame for the decision made in the vignette. The nature of the surgery would be in even the briefest of sign-outs available to the covering resident, and that means that the potential danger of lower urine output in that post-op patient would either be apparent or not apparent to a resident–whether the resident had been part of the case or not. (The sign-out from the primary resident should also have said, “if urine output decreases, do X, Y, and Z”.) And the resident would either be ashamed of his mistake and chastened by it or not, whether that day or three days after. Would the resident who had been at work for 20 hours and wanting to get out the door so he could come to work four hours later really be less inclined to “buff” the patient superficially rather than taking care to really work him up? I doubt it.
Handoffs are one place where medical risk is really scary–and work hour rules do potentially increase the time in which a patient is being covered by someone who is not their primary resident. But the goal should be quality coverage by different residents, not simply extending increasingly error-prone or apathetic coverage by the same primary resident.
Thanks for your responses everyone!
If I did become a doctor I’m concerned I would not have enough time for my kids. Working 80 hour weeks as a res is a necessary evil but I wouldn’t want to work that many hours the rest of my career. Is it unrealistic to expect to work less than 60 hours a week as a family doc?
sorry to rant off-topic…
Yes. You can work less than 60 hours a week as a family doc.
You might not earn much money. But that’s the choice you’d be making. Think about the finances in advance, though: you don’t want to get in so much debt to get your MD that you’re forced to work more than you want after you get it.
No problem about the rant
The cost of going to med school is a big worry to me. I would hate to end up working a lot more than I wanted just to pay off loans. Is there a good website to research starting off salaries compared to hours worked? If I had to work more than 60 hours a week to make ends meet as a doc I’m not sure I would want to make that sacrifice right now, while my kids are little.
I’ll be starting my new job as a family doctor in a few weeks. My current debt is $146,000; I’m paying it off at $700/month over 30 years (!! which means I’ll be paying student loans out of my social security!!) but frankly student loans are SO CHEAP (the interest rate is 3.2% on my consolidated loans) that I will gladly pay off my house and buy a car with cash before I try to speed up the payment on my student loan.
Anyway. I and my classmates are starting as family doctors making an average salary of $100 to $120,000. Then there’s something called “productivity,” bonus pay for exceeding billing targets. Most of us expect that we will take home at least $25 - 30K additional in productivity during our first year.
Family doctors and pediatricians are at the low end of the pay scale for docs. There are certainly lots of subspecialists making more, but for me personally, an income in the mid-100s is just fine and will be manageable with my debt. What’s manageable for you and your family will be different, obviously.
There are definitely easier ways to make more money but I love being a family doctor and don’t mind working ten hours a day to do it - I have a fairly conventional practice of office work. The other great thing about FP, though, is that you can customize it in so many ways. You can work part-time, you can do urgent care, you can work for specialized populations, etc. etc. Visit www.aafp.org and poke around some for articles that will demonstrate the wonderful variability of family medicine.
I was going to mention Urgent Care, Mary. I met a FP doc who quit her own practice to work for an Urgent Care because it allowed her greater flexibility of hours to be with her children and paid better (per hour) than her practice.
Another option (that I don’t know enough to express an opinion about) that my FP and OB/GYN are doing is to do cosmetic procedures in addition to their regular practice.
So, there are lots of options out there.
Thanks for the responses everyone!
The link was very helpful Mary! It sounds like it is possible to work a reasonable schedule and still be able to afford to pay loans back.
It is sort of a Joke among the FP docs: Definition of a specialist: someone whoes patients are all conditioned to only get sick from 9-5/ Monday through Friday.
not strickly true off course, but that is one of the reasons people choose specialties over Primary care - the hours tend to be a bit better.
Only in “lifestyle” specialties. Which are 4-5 at best. The rest have crazy. I would say that a FP private practice has better hours than the majority of any other field in medicine. Am I missing something?
Well I am not sure that we are agreed on our terms. To me, lifestyle specialties are probably more numerous than four or five. A lifestyle specialty, to me, means limited office or hospital hours and lots of time off. It might, but does not necessarily, mean shift work a’la E-med or anesthesia or hospitalist. No primary care doctor or general surgeon gets limited office hours or 6 weeks of vacation a year. In my own experience, pulmonologists in community hospitals who are covering critically ill patients are also racking up pretty heinous hours - but more and more, hospitals are hiring intensivists to do the hospital work.
Even with hospitalists taking over in-patient care for medical patients, primary care doctors are all still working a lot of hours. I get to work at 7:30am and am thrilled to be home at 6:00pm these days with “only” about another hour of work to do after I get home. That’s five days a week. I am pretty sure that there aren’t ANY subspecialists in either medicine or surgical subspecialties who are putting in those sorts of hours consistently. I know some FP docs who work 4-day weeks (the days are generally 12 hours long, though, and they’re doing office paperwork on their day off).
I like FP and am glad to be doing it, but not because the hours are cushy, that is for sure!!
Well Doc you have seen more than I. Lifestyle, to me, is all ample time off with a significant income…oh and no call and no pager.
The only FP’s I have experienced are those in private practice and they work 9-5 with weekends off. Like I said though you are in it and have more experience so I figure my sample is too small.
I’ll tell you that I don’t see me going into FP.
I am now an anesthesiologist & I would certainly lump my profession into the lifestyle-friendly end of the pool IF you wish to make it that way. ALL specialties (primary care & “specialists”) have the capacity…once you’ve earned the clout…to limit your hours to suit your lifestyle choices. Those limits do not come w/o sacrifice: loss of income, seniority, necessitating moving to another group/locale, loss of influence and so on. And, some specialities make much easier to accomplish, i.e: derm, path, ED to a lesser degree, anesthesia.
Let there be no doubt, your clissic primary care disciplines [IM, FP, peds] can & will consume lots & lots of hours and not just in the office setting. These guys do lots of work & call from home & on the road. I suspect that this is why you see a lot of IM/FP folks who staff rural/suburban EDs as opposed to hanging out a shingle to do primary care. The money, hours & call are much better. Unfortunately for those in primary care, they also tend to be on the bottom of the earning stick too. You would simply have to “love it” to do it.
I choose anesthesia because I love what I do. I love procedures, resuscitative medicine, taking care of sick/unstable pts, that fly-by-the-seat-of-my-pan ts feeling, the knowledge that when the poop stricks the fan the first dude you want there is the anesthesiologist and a complete absence of chronic care. The fact that the money is fantastic now certainly helped, but I’ve been around long enough to know that that is only temporary. I will put in a LOT of intense, high-stress hours in the OR, on call & in the ICU. But, I have much more capacity than a generalist to define that when I leave the hospital, I am just Dave, sans the pager or cell phone. But, I have had to ‘pay’ for that priviledge in length/intensity of training & the level of stress attributable to what I do all day long every day.
- OldManDave Said:
Let there be no doubt, your clissic primary care disciplines [IM, FP, peds] can & will consume lots & lots of hours and not just in the office setting. These guys do lots of work & call from home & on the road. I suspect that this is why you see a lot of IM/FP folks who staff rural/suburban EDs as opposed to hanging out a shingle to do primary care. The money, hours & call are much better. Unfortunately for those in primary care, they also tend to be on the bottom of the earning stick too. You would simply have to "love it" to do it.
I choose anesthesia because I love what I do. I love procedures, resuscitative medicine, taking care of sick/unstable pts, that fly-by-the-seat-of-my-pan ts feeling, the knowledge that when the poop stricks the fan the first dude you want there is the anesthesiologist and a complete absence of chronic care. The fact that the money is fantastic now certainly helped, but I've been around long enough to know that that is only temporary. I will put in a LOT of intense, high-stress hours in the OR, on call & in the ICU. But, I have much more capacity than a generalist to define that when I leave the hospital, I am just Dave, sans the pager or cell phone. But, I have had to 'pay' for that priviledge in length/intensity of training & the level of stress attributable to what I do all day long every day.
sounds great.....forgive my ignorance....what is an ED?
Probably Emergency Department… feel free to correct me.
ED = ER = emergency department/room
Sorry for the “jargon”
My mom (FP) has a schedule of 8-5 (last patient scheduled at 5) M,T,W,F off on R afternoons and has a second gig at the state mental health facility on R and some Saturday mornings. Her call is every 5th week (there are 5 partners).
She also is up at 5:30 am doing her dictations and/or up late doing them.
I think she has 6 weeks of vacation - it sure seems like she can take off when she wants.
It seems like a lot, but she also makes way more than the national average by putting herself out there. She’s a workaholic anyway.
I look forward to achieving the seniority that will give me six weeks of vacation! I think I get 3 wks/yr for the next several years… but except when I’m on call (which will be every 7 weeks) I won’t be working weekends, sweet!
Um, I should say I won’t be working weekends in the office, as I’m about to go do some work right now…