hi,
I have a question for third and fourth year med students. I’ve often heard that as residents you can’t expect to get more than five hours of sleep a day. How much of it is true? If so, why can’t you get more sleep? Do they really expect you to be on your feet for 16+ hours a day?
If they really don’t let you sleep there, how do you guys get used to it? Do hospitals hand out prescription strength stimulants to med students and residents?
Sorry if this question sounds stupid. I know I still have a lot to learn as a premed.
Mike
This won’t answer your question but I just have to post it. An undergrad prof at Georgetown told his students that anyone who sleeps more than four hours a night is an 'underacheiver.'
Whatever!
Sleep? What’s that?
On average, I work 65 hours week…more in the ICU, usually around 80/week. As for sleep…on non-call nights, I get 5 to 6. I would get more except I am a family man & maintaining a strong marriage & wonderful relationship w/ my 2y/o daughter take precedence over sleep. Of course, I also must read as close to daily as is feasible. Every evening, I look up my cases for the next day, research & read about them & discuss them w/ my attending.
On call nights are a totally different beast! As anesthesia on call, we cover all OR cases, all traumas, we intubate & line all CODE BLUES, cover OB for epidurals & C-sections and any emergent airway management anywhere in the hosp. To say that we are busy is the understatement of the year. Usually, we may grab 1 to 3 hours sleep, but that is in short stretches & almost never more than an hour a time. It is not unusual to never see the call room except to drop your stuff off & again when you pick it up to leave. However, our saving grace is that we have no “rounds” to pull off & we go home post-call around 8 or 9am. So, a call shift is usually only 24~26 hours long & we pull 3 to 5 calls/month.
ICU call - same story with the minimal sleep thing & the occasional no sleep at all nights. But, we pull q3 call! Furthermore, we have to round w/ the team the next day & never get out before noon & usually not until 1pm or so. That makes for approx 30 hour shifts.
Get used to it? Not really…don’t think you can truly get used to it in the sense that given the opportunity, you quickly revert back to a sleeping being. However, you do learn to function on surprisingly little sleep…and not just function, but be sharp, decisive & to do a lot of intricate problem-solving brainwork. It has to do with need. I can be literally a zoombie, but someone crashes & the juices get flowing and I am sharp mentally & able to perform complex technical skills smoothly & competently.
I would contest that most phsycians develop these same survival skills over the course of their training. If not for their own sakes, at least for the benefit of their patients.
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hi,
I have a question for third and fourth year med students. I’ve often heard that as residents you can’t expect to get more than five hours of sleep a day. How much of it is true? If so, why can’t you get more sleep? Do they really expect you to be on your feet for 16+ hours a day?
If they really don’t let you sleep there, how do you guys get used to it? Do hospitals hand out prescription strength stimulants to med students and residents?
Sorry if this question sounds stupid. I know I still have a lot to learn as a premed.
Mike
Hi Mike,
I am getting more sleep now as a PGY-3 General Surgery resident than I did when I was a first year medical student. I was in class from 8am to 5pm Monday-Friday. On Saturdays, I generally spent 12 hours in the Gross Anatomy or Pathology lab. I usually slept in until about 9am on Sunday and then studied most of the day.
On class days, I would get home around 6pm and be in bed by 7pm. I would get up at 12 midnight and study until 6am when I would get ready to leave for school.
As a resident, I work 80-hours per week which generally includes at least one 30-hour shift sometimes two. I arrive at the hospital at 5:45 every morning and I do not leave until after 6pm. When I get home, I generally study at least 2-3 hours each night and prepare for the next day’s cases. Just because I have graduated from medical school does not mean that I do not have to study and read. I also have to keep up with my journals too.
I have adjusted to life with little sleep. The only thing that has really suffered has been my workout time. I haven’t found a way to fit that in yet. I started setting a strict schedule in medical school and I have stayed with it.The hours are long but the work is totally interesting.
Natalie
Mike, you are going to get lots of different perspectives on the question of sleep. When you see an “average” number of hours of sleep, remember that residents (and med students on clinical rotations) have schedules that in any other line of work would be considered just plain weird. That is, we are on call one night out of every three, four, five - as opposed to showing up and going home at the same time every day.
I would guess that my average would come out to about five hours, and here’s how I figure it: Three days out of four, I go to work at 6am, get home around 6pm. I’m in bed from 9:30 to 4:30 or so, so that’s seven hours. Not bad, right? Not until you get to the fourth day, when I go to work at 6am, work through the night and into the next morning, and get home in the afternoon. Depending on what rotation I’m on, I may have gotten a little interrupted sleep in a call room or I may have been on my feet all night long - it just depends. But my nap the next day definitely doesn’t ever make up for the loss of a whole night’s sleep, that’s for sure.
So the way I figure it, I get 20-24 hours of sleep over four days - that’s 5-6 hours of sleep a day. Yes, it is hard. And I have to say that I don’t feel the adrenalin kick in and keep me moving in the wee hours, as Dave has described. I know some people do get a second wind when they’re going through a prolonged awake period, but I just kind of slog through it and get slower and slower and slower… (visual of Energizer Bunny slowing down and keeling over)
I was probably this tired when I was up with new babies, I don’t remember. There are certainly people in all sorts of other lines of work who aren’t getting enough sleep, so I don’t feel special for it. Just tired.
Mary
I’m in an experimental pilot program for third year, which means that I can’t speak to the average third year’s experience–but I can say that there are some nights when I’ve had call all night or was delivering a baby all night and then had to keep going all the next day. And I was tired as hell. But you know what? Medicine is really freaking cool. When there is a baby being delivered and you get to be a part of it, you WANT to stay up all night. Or, I do anyway. I think that being excited makes up for a lot of the sleep deprivation–if you can make it up later. On weeks when it’s just day after day of <6 hrs/night of sleep, after five days of that I’m pretty brutalized and I’m a pretty cranky guy. But usually you get some time to catch up on the deficit eventually.
joe
And many hours later–it’s 2:20 am as I write this–I’m stoked as hell because we just did an appendectomy and the surgeons got his huge appendix out without rupturing it, and I got to staple the incision shut at the end. Now some Hot Pockets gleaned from the resident fridge and then to a couch where I’m going to crash for the next few hours. And, really, I love this.
j
Disclaimer, though most of you know this, I am not a doctor nor med student but most of my life I have had jobs that reuired me to forgo sleep.
The campaigns I have worked had me getting 2-3 hours a night for weeks at a time and it was just the way it was. Some of it was cool, not as cool as what Joe’s talking about, by seeing Air Force One land is cool. Even if it’s at four in the morning, though I’ll admit I didn’t always look that great during these periods of time.
Hey, I am no med student either, but I have just started this shadowing deal in the ER where I was up til 2 am yesterday after having been up since early in the morning. It was so cool I did not at all want to leave and go home to sleep! I already think I have become addicted. Before I actually had this experience I would have said such an attitude was demented and self-aggrandizing, but actually being there seeing all the stuff happen in the ER and be talked to about it is so cool! I would have gotten up at 6 am to go back there if they’d asked me to.
You think it is cool to watch…just wait until YOU are the one doing the stuff! Then, it is totally awesome. I still sometimes sit & think - WOW! And I get paid to do this!!!
Even though I am just now approaching 2 years as a physician & have many years of healthcare/ICU-level experience under my belt, I still marvel at how I have trained myself to function under duress. The actions, in many ways, are becoming more intuitive & instinctive leaving me with more & more ability to devote my brainpower towards the problem solving aspects while I performing skills such as intubation or placing lines.
It only gets better!
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You think it is cool to watch…just wait until YOU are the one doing the stuff! Then, it is totally awesome. I still sometimes sit & think - WOW! And I get paid to do this!!!
Even though I am just now approaching 2 years as a physician & have many years of healthcare/ICU-level experience under my belt, I still marvel at how I have trained myself to function under duress. The actions, in many ways, are becoming more intuitive & instinctive leaving me with more & more ability to devote my brainpower towards the problem solving aspects while I performing skills such as intubation or placing lines.
It only gets better!
How on earth do you ever get to where you can DO that stuff? I walk into a room and see a patient and can’t even figure out where their heart and lungs are. Normally I am a sociable, easygoing person but when I follow the doctor into the room, I freeze up and get all nervous. Still I think it’s cool and I am not regretting that I’m not home sleeping, but I feel like there is this huge chasm between me, premed who knows zilch, and person who can actually do something useful.
I definitely love the settings where things are moving at a fast pace and decisions have to be made quickly. Like I said I’d stay up all night to see more of it.
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How on earth do you ever get to where you can DO that stuff? I walk into a room and see a patient and can’t even figure out where their heart and lungs are. Normally I am a sociable, easygoing person but when I follow the doctor into the room, I freeze up and get all nervous. Still I think it’s cool and I am not regretting that I’m not home sleeping, but I feel like there is this huge chasm between me, premed who knows zilch, and person who can actually do something useful.
Not to sound cruel or arrogant - but you are a premed who likely does not possess sufficient knowledge/skill to significantly contribute NOW. That is why we go to school & train for years - in effect, for a professional lifetime. It takes years to get where I am & I am no where near where I need to be in only just over 2 years, when I will become an attending level physician - DAMNED SCARY! You nor I can ever truly master the body of knowledge that is “physician”…but we can certainly strive to do so in the interest of delivering the best & most consciencious care we can feasibly deliver to our patients.
Oh…let me clarify my opening claim a little - it sounds way more harsh than how I practice. I have learned over many many years in healthcare 1 very important corollary: Everyone you encounter (colleague, patient, family, student, nurse, resp terrorist…housekeeper) has something of value to teach you. It is your job to be open & receptive to that lesson.
So, relax in the knowledge that all of us, no matter what level we currently function upon, at one time got the sweaty-all-overs just thinking about the tasks we can now routinely perform after being awoken in the middle of the night or without having had any sleep.
You are not born capable - these abilities are honed over years of education & training.
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Not to sound cruel or arrogant - but you are a premed who likely does not possess sufficient knowledge/skill to significantly contribute NOW. That is why we go to school & train for years - in effect, for a professional lifetime. It takes years to get where I am & I am no where near where I need to be in only just over 2 years, when I will become an attending level physician - DAMNED SCARY! You nor I can ever truly master the body of knowledge that is “physician”…but we can certainly strive to do so in the interest of delivering the best & most consciencious care we can feasibly deliver to our patients.
Oh…let me clarify my opening claim a little - it sounds way more harsh than how I practice. I have learned over many many years in healthcare 1 very important corollary: Everyone you encounter (colleague, patient, family, student, nurse, resp terrorist…housekeeper) has something of value to teach you. It is your job to be open & receptive to that lesson.
So, relax in the knowledge that all of us, no matter what level we currently function upon, at one time got the sweaty-all-overs just thinking about the tasks we can now routinely perform after being awoken in the middle of the night or without having had any sleep.
You are not born capable - these abilities are honed over years of education & training.
Ha ha ha, OMD, I have to laugh at how seriously you took my question! Duh, I already know that I don’t know anything. I mean, where on OPM have I EVER posed as a knowledgable medical practitioner??
You’ll need some target practice if you really want to make me feel like the victim of cruelty! (again, big grin). But anyway, I am doing this shadowing thing where I have to go listen to patients’ hearts and lungs all the time. And then come back and report what I heard, such as whether the patient had a murmur (and what kind) or if they seem to have fluid in their lungs. If I can’t explain what I’m hearing well, or if it doesn’t sound like what the doctor hears, I get kind of chewed out. But ok, I have no training! I don’t even know how to position a stethescope, or what side of it to listen with. (Well, now I am starting to learn but I didn’t know this a week ago.) It’s weird to actually interact with the patients in this way for the first time. Anyway, you could just have said that the accumulation of all that exposure during medical school and residency is where the knowledge and confidence comes from. My question wasn’t exactly literal, it was rhetorical. I of course don’t fail to appreciate the fact that residents have more experience than premeds.Plus, I wrote that post as a person who has zero knowledge, and is shadowing doctors who are well past residency–hence the chasm and feeling of awkwardness I mentioned.
Oh, and another thing: I was at the doctor myself a couple weeks ago, and the attending doctor asked if he could let a medical student help. I noticed along the way that the medical student had an overall sort of stiff, nervous air. It didn’t matter in the slightest to me that he was there, but I did reflect on the fact that his attitude (while commendably studious) did not put me, as a patient, at ease. People who look formal and uptight make everyone feel that way. So when I am following doctors into patients’ rooms myself, I am thinking, what can I do just as far as being here that won’t make everyone in the room feel nervous? Body language has a lot to do with that, I think, and that was part of what I was getting at. Wearing scrubs makes me feel more comfortable too!
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Oh, and another thing: I was at the doctor myself a couple weeks ago, and the attending doctor asked if he could let a medical student help. I noticed along the way that the medical student had an overall sort of stiff, nervous air. It didn’t matter in the slightest to me that he was there, but I did reflect on the fact that his attitude (while commendably studious) did not put me, as a patient, at ease. People who look formal and uptight make everyone feel that way. So when I am following doctors into patients’ rooms myself, I am thinking, what can I do just as far as being here that won’t make everyone in the room feel nervous? Body language has a lot to do with that, I think, and that was part of what I was getting at. Wearing scrubs makes me feel more comfortable too!
If you can squeeze in an EMT class, do it. After completing it, you’ll be much more comfortable with patients and you’ll learn information which will allow you to ask better questions.
I originally began the course to get over my fear of sick/screaming people (no lie!). I’m glad I did. It’s been more rewarding that I’ve ever imagined.
I’m building confidence. The knowledge I’m learning helps while overhearing conversations. I can pick up little interesting details of how the doctor is assessing patients since I have an idea of what is supposed to happen.
Plus, my first ride out on an ambulance was nuts. It was a freeway speed head on collision with a fatality. Three patients were flown to hospitals. The patient I took to the hospital had an open compound ankle fracture. I often wondered how I’d react to gore (tendons, both lower leg bones visible, and even fatty tissue-it was nasty). And just imagine the looks I got from the staff where I volunteer. It took them by surprise when I brought them this patient and…I think they were even a little proud.
Even with the small amount of training as an EMT, it’s like a switch flips and you do what needs to be done. It’s an amazing feeling when the training kicks in and even better when you’ve helped somebody. Not bad for a 6 credit hour course.
It definatly gives me something to reflect on when trudging through premed classes and provides motivation.
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You think it is cool to watch…just wait until YOU are the one doing the stuff! Then, it is totally awesome. I still sometimes sit & think - WOW! And I get paid to do this!!!
Even though I am just now approaching 2 years as a physician & have many years of healthcare/ICU-level experience under my belt, I still marvel at how I have trained myself to function under duress. The actions, in many ways, are becoming more intuitive & instinctive leaving me with more & more ability to devote my brainpower towards the problem solving aspects while I performing skills such as intubation or placing lines.
It only gets better!
How on earth do you ever get to where you can DO that stuff? I walk into a room and see a patient and can’t even figure out where their heart and lungs are. Normally I am a sociable, easygoing person but when I follow the doctor into the room, I freeze up and get all nervous. Still I think it’s cool and I am not regretting that I’m not home sleeping, but I feel like there is this huge chasm between me, premed who knows zilch, and person who can actually do something useful.
I definitely love the settings where things are moving at a fast pace and decisions have to be made quickly. Like I said I’d stay up all night to see more of it.
Ifelt like I was lost my first few months as an RN and the WT of responsability, and I know I will feel the same as a resident, it hits you that you have the privilage of caring for people, and what a great privilage!
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You think it is cool to watch…just wait until YOU are the one doing the stuff! Then, it is totally awesome. I still sometimes sit & think - WOW! And I get paid to do this!!!
It only gets better!
Thank you (and Joe) for posting this. I have to admit, I get cold sweats when I see threads like this - “You’ll get no sleep, have no life, gain weight, never read a book again, end up getting a divorce, etc, etc.”
It helps to be reminded sometimes why I want to do this in the first place, and it helps to have someone who is ahead of me admit that the process IS worth it.
Erica,
I will be totally honest with you - there were times, esp during my internship, where I would think, “OMG, what in the hell was I thinking?” But, now that I am beyond the hell that was internship & doing something I truly love doing - I know beyond any shadow of doubt that I made the right decision to become a physician &, even more so, an anesthesiologist. However, this was not something that ‘came to me in a vision’ or the toothfairy whispered into my ear. A TON of blood, sweat & tears went into the whole process - and even more communication & compromise b/t my wife & I - to be rewarded with this level of satisfaction. Furthermore, at the core of my success is the art of balance. It has taken years to evolve, and there is still more work to be done to reach “perfection”, but I have learned how to balance my obligations b/t life & profession…mostly the hats of dad, husband & physician. I still need to do much much better learning to take care of myself & treating my needs as important too.
But, these are all critical skills that must/should be learned to be happy with yourself, life & career no matter what you did for a living. Its just that for people who choose to enter demanding professions, that skillset much be polished to a high gleam. I am working on getting to that level of performance!
As an intern, I’m averaging around 5 hours a night when I’m not on call. Occasionally I’ll get a full 8 but those are ‘special occasions’.
I’m in the MICU this month. When on call, I may (if I’m lucky) get an hour or two of sleep. Like many folks here, we do 30 hour calls. Frequently, that’ll be 30 hours without sleep. By the end of call, it truly sucks. I start to feel physically ill and know I’m cognitively slower than I was at the start of the shift.
The good news is that what used to seem like a mere 4 hours of sleep now seems like more than enough.
The REALLY good news (for me anyway) is that I’m an EM resident. We don’t do call. This month is the last time I’ll ever have to take call and I’m only an intern.
Take care,
Jeff