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General surgery resident in the US on a 28 hour shift. AMA!
Hi everyone! I am new to Tildes and wanted to say hi to the ~Health community. I am on a 28 hour emergency general surgery call today and have a bit of downtime. I also noticed that the post on the moral crisis of America's doctors had some interest so I thought I would answer any questions about that or training to be a surgeon in the United States. I am finishing my 2nd year of a 7-year training program. Ask me (almost) anything!
I preface this comment with this; everything I know about working in a hospital I learned from watching Grey's Anatomy with my wife.
So my question is, how often are you having sex in a supply/janitor's closet and/or breakroom?
Just kidding! Thanks for doing what you do. I hope you have a quiet 28 hours.
Haha I have heard stories. I am married though and try to keep my personal life away from the hospital as much as I can.
You're married AND a surgeon? My daughter was heading toward being a cardiac surgeon, and during her rotations noted a few things: All the surgeons seemed to be part of an 'old boys club' and they didnt particularly like or appreciate a woman coming into their specialty; and a cardiac surgeon seems to find it nearly impossible to have time for a family and knowing she wanted kids, she switched her specialty. In all of her training she only came across one other woman in a cardiac surgery specialty and she was single.
Is that true where you are too? (She's in Canada)
The culture is getting better. Cardiac is bad, I have effectively ruled that specialty out. Once the training is over if you find a good position maybe you can eke out a reasonable quality of life if you have good partners and mostly elective cases and someone else managing ECMO. The training is atrocious. 100+ hour weeks for years. And at home you are doing research, studying, living, and breathing cardiac surgery. I know one female cardiac surgeon but I don't know much about her at all. I see the cardiac ORs running all night long. They are operating when I leave the hospital at night, and operating when I get there in the morning.
Some specialties are better. Breast surgery has no emergencies and is a primarily scheduled breast cancer surgeries. It also tends to attract more women and patients in my experience appreciate female physicians.
Knock on wood! :D
Do you have strong feelings about whether the US should adopt universal health care? Has the overturning of Roe v. Wade & subsequent laws changed your day-to-day?
I am in a blue state. I have heard from my ob-gyn colleagues that they are getting patients from red states who are asking for abortions and are at higher risk due to delays in care.
Like most of this community I am left-leaning. I think healthcare is a right, not a privilege and everyone should have access to high quality healthcare. I think that poor primary care is making Americans sicker and this is costlier in the long run. I have amputated too many legs due to poorly controlled diabetes for my comfort. I hate that patients are being punished for having medical conditions and lack the support they need.
I also have worked in a lot of government run hospitals. The bureaucracy and inefficiency at the VA is second to none. The poor quality of care at county hospitals makes my stomach turn. I am worried that with the ballooning costs of healthcare globally the government simply wouldn't be able to keep up with the needs of our country. I don't have a solution and am worried about what the next twenty years will look like for the aging population as well.
I found surgeons tend to be right-leaning even in my blue state. Usually, this is because they are strongly independent people who dislike government interference in their daily practice. They feel like they are able to provide better care when there is less regulation. To an extent, I believe them.
Thank you for the reply.
I've struggled with a chronic health issue (narcolepsy) for years- if i lose employment, i lose medication, and have that much harder time finding work again because i cannot control my symptoms.
I worry very much about what the next 20 years will bring, too. I may sleep 16 hours a day without meds, but at least I won't drop dead or lose limbs.
Yes I have patients who also have to change hospitals due to employment changes. I find this to be super frustrating from a physician standpoint. They have their own surgeon who has done multiple surgeries on this patient and known them very well. Then they get transferred to us and we have to start from the bottom figuring out what surgeries have been done, what medical treatment has been attempted, what needs to be done.
My advice for anyone here is to keep meticulous records of their medical care and especially operative reports (which you often have to ask your surgeon for) because on our end it's very piecemeal.
No hallucinations yet.... I do feel a bit slower. When talking to patients in the morning sometimes I have to take extra time to think about what I am going to say next. I think my reaction time is a bit blunted but I rarely have to do anything technical after 22+ hours, usually the fresh team comes on by then. Usually.
Are there regulations (or even just work practices) on how long you're allowed to perform actual surgery before you're expected to step away? I used to treat people on a much less intensive level, and I found that after my 12h bouts I could barely question someone about their symptoms.
For residents the max we are allowed to work are 28 hours straight. We also cannot work more than 80 hour weeks averaged over 4 weeks. (OK to work 110 hours one week and 50 hours the next week).
As an attending surgeon there are zero regulations. I have seen attending surgeons pass out from exhaustion.
Oh I responded to @Suuncle about this also but I am curoius:
How do your 24 hour shifts work? We often do Q3, which is every three days it's a 28 and the day in between is either off (Sat, Sun, Mon) or 12-hr (Tues, Weds, Thurs, Fri).
When we have day/night teams it's usually a 14 hour day shift team and a 12 hour night shift team with alternating 24s on weekends. My least favorite schedule was 6pm-6am 6 days a week.
Oil drilling? How do the magnetic fields matter?
Ok, that is absolutely insane.
I take it you're on the engineering side of things, and not one of the people one can occasionally see getting into OSHA-type situations?
What exactly is general surgery and what types of cases would you typically deal with? How early on in your training do you specialize (if at all)? I imagine being a surgeon is a high pressure job at times — how do you manage that?
General surgery historically was the basis of surgical training and afterwards surgeons would pursue additional training to sub-specialize. Today surgeons tend to specialize earlier and pick a path at the end of medical school. Specialties such as orthopedic surgery, neurosurgery, ENT and head and neck surgery are separate training pathways. Other specialties that were originally from general surgery are also now separating (plastic and reconstructive surgery, vascular surgery, cardiac surgery, thoracic surgery). This leaves general surgery with surgery involving the alimentary tract (esophagus to anus), hernia surgery, skin and soft tissue surgery, biliary tract surgery (gallbladder removal), some endocrine surgery (thyroids, parathyroids, adrenals), cancer surgery involving the GI tract, solid organ transplant surgery, breast surgery, and trauma surgery. General surgeons are also qualified to run surgical ICUs and we spend lots of time training in various ICU settings.
The pressure is constant but I am adapting to it. I found first year to be more stressful even though second year is higher stakes and more responsibilities. I find stress increases in unfamiliar situations which fortunately are less and less as my training goes on. Stress also increases when the number of things I need to do is higher than the amount of time I have in a day, and as I have gotten more efficient this is also less often. I wouldn't say this field is for the faint of heart.
My mom did nursing school and worked at a children's hospital during the same time on night shifts. She was able to do it by drinking two of those large monster cans, you know the ones where you unscrew a lid to drink?
Do you have an energy ritual while working these 28 hour shifts?
Most of my colleagues use energy drinks. I find it gives me a bad stomach ache and I get jittery and can't focus when I need to. I drink a coffee in the morning and do my best to stay hydrated. I usually have some snacks like nuts, trail mix, beef jerky during the day and nights. I try to sleep when I can. On a good night I can get 4 hours of sleep. On a bad night it's zero.
Wow I don't know how you do it. I've worked 24 hour shifts but my primary job was to sit and keep watch of equipment. I start to get sick when I get really tired with migrains and nausea. Thank you for what you are doing :)
How do your 24 hour shifts work? We often do Q3, which is every three days it's a 28 and the day in between is either off (Sat, Sun, Mon) or 12-hr (Tues, Weds, Thurs, Fri).
When we have day/night teams it's usually a 14 hour day shift team and a 12 hour night shift team with alternating 24s on weekends. My least favorite schedule was 6pm-6am 6 days a week.
This was while I was in the military so the shifts were monthly or every few months in my unit. The shifts from my recollection were 9am-9am, if the person that was supposed to replace me got there in time. We are ordered to never leave our shift until we have a replacement. There have been times were it would be 9am-2pm next day just because the replacement wasn't there in time or needed a replacement for the replacement because they were on vacation.