What are some healthy activities you can do? Let’s take a look at what IM is and what you can expect from an IM residency. Even with caps on hours worked, it’s not uncommon to go beyond this amount. Are you considering going into Internal Medicine? Family Medicine tends to give more space to developing people skills, communication skills, and a public health or community health perspective. Most Sports Medicine fellowships require a FM residency. In general, IM is considered a less competitive speciality, simply because the number of positions available to match into is very large compared to other specialties. Amy Rakowczyk is a medical spouse, mother, writer, singer, and former voice instructor. 1. Check them out: Best of luck to you as you make your decisions and apply for Match! You summed it all up very nicely! The major difference in most programs is the amount of time you spend in the hospital versus the outpatient clinic. If you dream of going into Cardiology, finding a program that hosts a large Cardiology fellowship program could boost your chances of landing that dream job. Long and unpredictable work hours have been a staple of medical training for centuries. The Vanderbilt Internal Medicine Program is committed to compliance with the ACGME duty hour guidelines. We compared the patient outcomes of newly independent doctors — first-year internists just out of residency training — before and after 2006. What is the difference between a physician who is intoxicated and one who has not slept in 24 hours? Generally, an employee can work more than 48 hours in a work week only if he or she has agreed electronically or in writing and was provided with the document entitled “Information for Employees About Hours of Work and Overtime Pay,” published by the Director of Employment Standards, before the agreement was made. Full-time refers to employment where the normal hours of work is at least 35 hours a week. According to studies and resident reports, 70-80 hours per week during hospital rotations and 40-50 hours per week on outpatient clinic rotations is normal for this type of residency. New York State was 15 years ahead on this, having mandated an 80-hour work week in 1989, stemming from the Libby Zion case. According to the American College of Physicians, Internal Medicine is a science that represents the best of both worlds. This is pretty standard for most surgical interns. This is particularly relevant today, as any small gaps in an individual doctor’s expertise can likely be mitigated by the increasingly team-based nature of medical care and the growth in health care technologies, including electronic health records and various safety systems. Med-Peds (Internal Medicine and Pediatrics), EM-IM (Internal Medicine and Emergency Medicine), or Internal Medicine and Psychiatry are examples of dual training programs. Under these contracts it is possible for residents to work up to, and in some cases to exceed, 80 hours per week. Some programs follow a more traditional schedule which consists of hospital rounds in the morning and clinic in the afternoons. The current work conditions vary drastically from the old days when the number of hours worked per week were 100 – 120. Analyzing the outcomes of nearly 500,000 hospitalized patients in the U.S., they found that newly independent doctors who trained in a period where they routinely worked 90 to 100 hours per week had no better patient outcomes, despite the additional hours spent in training, than doctors whose residency training involved substantially less time in the hospital. You’ll need a regular exercise routine, time to socialize outside of work, and time to read or enjoy things that are not related to your residency. Typically the work week for someone working full-time is 40 – 60 hours plus one to two nights of call per month. Hours by Gender. What’s the weekly workload in terms of hours worked during an Internal Medicine residency? Harvard Business Publishing is an affiliate of Harvard Business School. Hospital training makes it easy for IM residents to go on to do hospitalist work, but if they want to land in an outpatient clinic there may be some additional professional development required. In fact, the term "resident" is a relic of times when physicians in postgraduate training literally lived at the hospital. Many programs are shifting now to various block schedules (4+1, 3+1, etc) meaning you get a week or two of clinic every few weeks to break up the long days on the hospital shifts. Internists (and pediatricians) spend a much larger portion of their core training in the hospital setting compared to FM physicians.Â. This combination enables doctors to treat both common illnesses and complex, as well as long-term, medical conditions. In a landmark study, Williamson and Feyer compared volunteers who were sleep deprived and those who were intoxicated. We log every week exactly as we worked. If you have a spouse/partner, family and friends, or a group you’re part of, you can lean on them for support. You will need some downtime when possible. This ACGME Common Program Requirement states that “Clinical and educational work hours must be limited to no more than 80 hours per week, averaged over a four-week period, inclusive of all in-house clinical and educational activities, clinical work done from home, and all moonlighting. When you’re in clinic seeing patients, it’s possible to follow a more typical 8-10 hour day. That was just expected. B. Moonlighting (internal or external) must not interfere with the ability of the resident to achieve the educational goals and objectives of the residency program. Her hus... Amy Rakowczyk is a medical spouse, mother, writer, singer, and former voice instructor. New York State Department of Health Code, Section 405, also known as the Libby Zion Law, is a regulation that limits the amount of resident physicians' work in New York State hospitals to roughly 80 hours per week. Residents want the work experience, and there are often work cultures that … It may not display this or other websites correctly. In order to handle the long hours, stress, and physical requirements of the profession, work to avoid spending 100% of your time and energy on your residency. “The length of the work day fell sharply between the 1880s, when the typical worker labored 10 hours a day, 6 days a week, and 1920, when his counterpart worked an 8-hour day, 6 days a week. Becoming a doctor has always been difficult. Good article. Many residents say that wards are the most arduous part of their rotation as well as overnight call. Maximum hours worked per week: Duty hours must be limited to eighty hours, … Internal Medicine is a broad speciality that encompasses foundational medicine training (often called categorical training) as well as many sub-specialities such as Cardiology, Gastroenterology, and Infectious Disease. You can’t work more than 48 hours a week on average - normally averaged over 17 weeks. In July 2003, the … The law was named after Libby Zion, who died in 1984 at the age of 18 under the care of what her father believed to be overworked resident physicians and intern physicians. This law is sometimes called the ‘working time directive’ or ‘working time regulations’. Any trends in their patient outcomes over time should reflect only changes in the quality of hospital care, rather than any impact on care of having worked fewer hours during residency training. The findings contribute to current concerns about the epidemic of burnout among physicians. If you’d like to work in the hospital setting with adults and children, or want to leave the door open to work with children outside the hospital in addition to adults, you may want to consider Med-Peds. Residents refer to Singapore Citizens and Permanent Residents. Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in- house call activities and all moonlighting. They care for only an adult population and can work in the both hospital and outpatient setting. Your key to success will be having some systems in place. Do you envision your future as a faculty member at an academic medical center? We had 4 medicine residents covering 200+ patients with 15-20 new admits a night. Likewise, FM physicians can go on to do hospitalist work, but it might take some extra effort and/or training to catch up to their IM peers in the hospital (depending on the individual’s residency program of course). They found that a person who has stayed awake for 24 hours functions with the same diminished cognitive skill of someone with a blood alcohol level of 0.10. Some programs may try to observe resident duty hour rules more strictly. There may also be periods of study or research, which are much more relaxed in terms of schedule. According to studies and resident reports, 70-80 hours per week during hospital rotations and 40-50 hours per week on outpatient clinic rotations is normal for this type of residency. California’s overtime rules apply to California residents as well as out-of-state nonexempt employees temporarily working in California. France has a slightly … In the U.S. it requires four years of college followed by four years of medical school and, depending on the specialty, three or more years of residency training, a period when doctors routinely work up to 80 hours a week. On the other hand, additional training may be at the “flat of the curve,” meaning extra hours spent in the hospital offer little marginal benefit in terms of added expertise. Remember, this residency includes everyone who will go on to apply for any IM sub-specialty fellowship, in addition to all the people who decide to practice general IM. It may then come as a surprise that becoming a doctor is actually easier than it used to be, at least in terms of time spent on the job. Relatively few fellowships accept residents from both FM and IM. You likely can divide up your time how you wish. Sometimes these fellowship programs don’t hire from within. I am currently a first year resident (aka intern) in orthopaedic surgery. Resident doctors in the 1980s, for example, sometimes worked more than 100 hours a week, with hospital shifts frequently lasting more than 30 hours at a stretch. On the other hand, if you’re not sure if you want to sub-specialize or do a lot of research, or if there is a program close to home or that has a reputation for treating its residents well, don’t shrug these off as sub-par or undesirable. There are a few key elements that vary between IM/Med-Peds and Family Medicine. One common question that arises is what the difference is between doing an Internal Medicine (IM), Med-Peds, or Family Medicine (FM) residency. The statutory limitation of 45 hours per week means that the employee may not work more than 45 hours per week normal time. Today the average resident finishes with around 900 operative cases. One surgeon noted in a recent article, “When I trained, good or bad, I worked about 120 hours a week. When you are working inpatient, your hours worked per day can be quite long. ED Shifts are either 10 or 12 hours in length and are either 7 am to 7 pm or 7 pm to 7 am. Family Medicine requires training in obstetrics, which would not be a part of IM or Pediatrics residencies. But a similar decline was observed for 10th-year internists, whose patient mortality rates fell from 11.2% to 10.4%. Under the ACA, employees who work 30 or more hours per week are entitled to health insurance; however, beyond that, companies may … How hard is it to get into IM? In 2009 one physician wrote to the editor of the New England Journal of Medicine that, as a result of the 2003 reforms, “We now force [residents] to leave a patient with whose treatment they are intimately involved or to cease the observation of an instructive surgical procedure midstream. Hours worked per week Days off per week Vacation weeks per year Dermatology 45.0 1.9 … The opportunities abound for both men and women. Lastly, consider the general mindset that is instilled into people who train in FM versus IM, and how you tend to think about medicine as well. You can also talk to your residency director about programs and resources to help residents handle burnout and stress, or deeper issues like depression, substance abuse, or other unhealthy behaviors. About half of residents become general internists and the other half sub-specialize.Â. Traditional Standard Workweek . However, keep in mind that these rules specify a weekly limit that is averaged out over four weeks. Medical resident work hours refers to the (often lengthy) shifts worked by medical interns and residents during their medical residency. Because mortality fell by a similar amount for both the treatment (doctors who worked 80-hour weeks) and the control group (doctors who worked 100 hours), the decline can’t be attributed to hours of training and is more likely due to hospital quality improvements. California. The reason for these grueling hours: a belief by many in the profession that long hours were a rite of passage necessary for giving doctors the clinical skills to practice independently. Employees who earn above the determined threshold amount must negotiate the normal amount of working hours per day or per week with the employer. Comparing doctors who completed their training before 2006 with those who completed theirs after it, 30-day mortality rates for hospitalized patients treated by first-year internists fell from 10.7% to 9.9%, a change that could incorrectly be used to argue that working fewer hours in residency led to better-trained doctors. Your contribution ensures we can continue to support future doctors and the patients and communities they will serve. Because residency work-hour reforms were implemented in 2003, internists who completed residency after 2006 would have been exposed to a cap of 80 hours per week for their entire three-year residency, while internists who completed residency before 2006 would have worked longer hours for one or more years of their training. However, even with caps on hours worked, it’s not uncommon to go beyond this amount.Â, How would that happen if it’s not allowed? France. While physician sentiment toward long work hours has softened, many doctors, often those who trained in an era without restrictions on work hours, still question whether doctors today are as well-trained as they used to be. In 2003 new reforms prohibited resident doctors from working more than 80 hours per week and limited shift lengths to 24 hours. The standard for full-time employment was typically 40 hours a week in the past. It is one of the largest specialities in terms of numbers of residents. I finished with twice as many.”. Amount of hours worked per week varies between each rotation, however, typically a resident can expect to work about 50-60 hours a week. What are some strategies you can put into place to help you de-stress and relax? All residents are on duty no more than 80 hours per week, averaged over four weeks All residents have at least one 24-hour period completely off from all duties every 7 days, averaged over four weeks Many doctors worried that the reduction of training hours would hurt the quality of medical training, erode professionalism, and hurt new doctors’ ability to witness firsthand the hour-by-hour progression of a critical illness — all of which could lead doctors to have less experience on which to base future treatment decisions and insufficiently prepare them for the long hours and patient commitments required in real-life practice. To account for the fact that overall hospital care has improved over time, we used as a second control group doctors who completed residency 10 years earlier. She currently resides in Galveston, TX with her husband and tw... High Yield: One Year of Research for the Rest of Us, Residency will challenge you in unexpected ways, The Curbsiders – An Internal Medicine Podcast…for the Internist, IM Reasoning – Your Favourite Clinical Reasoning Podcast, Hospital and Internal Medicine Podcast with Dr. Porat –Â. This study — a… If you end up doing either general hospitalist work or outpatient work, it may not matter much which path you took in residency. The average full-time employee’s workweek in France is 38.9 hours. Although there are no serious proposals to rethink residency training hours, it’s an open empirical question worth investigating. If you want to dive into the exact facts and figures, you can see the NRMP’s report here. In accordance with the new common program requirements dated July 1, 2011: as of July 1, 2011 the following requirements apply to the Internal Medicine Residency Training Program at Vanderbilt: 1. In a new study, researchers found that an 80-hour workweek seems sufficient for training a doctor. A. Most residents will complete 14-15 ED shifts over the 4-week rotation. We looked at the same three patient outcomes for these doctors, who were never exposed to work-hour restrictions during their residency training. If the intense nature of residency training is a prerequisite for doctors to deliver high-quality care once they enter independent practice, simply because a large number of hours spent treating patients is absolutely necessary for clinical expertise, then it may be difficult to further reduce resident work hours without compromising downstream quality of care. It may be hard to imagine why many in the medical profession would have believed that an additional 10 to 20 hours in the hospital each week would make for a better-trained doctor. Are you planning to sub-specialize? Some academic medical centers reserve a portion of their fellowship positions for residents at their own institutions. ED and Admitting Resident Rotation. Most contracts stipulate a maximum number of consecutive hours that can be worked. IM, work around 72-80 hours per week, except clinic week which is 40-50. Many ob-gyns work 4 days per week, or sometimes half-time. This was a "cush" private hosptial. We similarly found that spending fewer hours in the hospital during training had, on average, no effect on internists’ hospital readmission rates or costs of care when they subsequently entered independent practice. Any of the IM sub-specialties, such as Cardiology, Gastroenterology, and Hematology/Oncology require an IM residency. IM also has some great podcasts out there. But they were hotly contested. Internal Medicine tends to focus on generating expertise in diagnostic skill and medical knowledge. We found that newly independent doctors who trained in a period where their residency work hours routinely reached 90 to 100 hours per week had no better patient outcomes, despite the additional hours spent in training, than doctors whose residency training involved substantially less time in the hospital. We also looked at second-year internists — those who completed residency two years earlier — and found identical results. However, highly respected and top-rated program are quite competitive to match into. Well-known academic centers tend to have good track records for matching their resident graduates into sub-specialty fellowships. These grueling hours were viewed by many as a necessary "rite of passage" and we… She enjoys helping other spouses navigate the world of medicine and actively participates in support groups and activities. but then it’s one of the exceptions. If you know you want to do general medicine in the outpatient setting for all ages, strongly consider Family Medicine. However, even with caps on hours worked, it’s not uncommon to go beyond this amount. California employers must pay overtime to nonexempt employees for all hours worked over 8 hours per day, or 40 hours per week. While physician sentiment toward long work hours has undoubtedly softened, many doctors, often those who trained in an era without restrictions on work hours, still question whether doctors today are trained as well as they used to be. There is no one-size-fits all for each doctor or each program. Spend some time around doctors in both of these fields and get the feel for this difference. Among the respondents, 834 residents (3.3% of the responding residents) in 370 programs (24.8% of responding programs) reported working more than 80 hours per week during the previous 4 weeks. • Take the average number of hours worked per week (59.6) • multiplied by the average number weeks worked per year (48) • multiplied by the average number number of years worked (36) • Then add the total number of hours spent training (40,000) • Lifetime hours worked = 142,989 However, be sure to ask how many of their current fellows in your desired sub-specialty graduated from their internal medicine residency. Our findings relate to the current epidemic of burnout among physicians — more than 40% of U.S. physicians reported experiencing burnout in several studies — a phenomenon that often starts during the busy years of residency training. You will be board-certified if you graduate from any accredited program! level 1 However, many employers now consider employees as full-time when they work fewer hours (i.e., over 30 hours, 35 hours, or 37.5 hours). It requires time management and self-regulation. Internal Medicine residency programs are three years and sub-specialty fellowships extend training by two or more years. (These outcomes were patient mortality and readmission to the hospital within 30 days of being hospitalized, as well as the costs of care.) On average, I worked 11.1 hours each day: 8.46 hours per day if I was on scheduled shift work such as in the emergency department or urgent care and 12.93 hours per day if I was on Inpatient Wards.Since I spent 9 out of 12 months of the year doing inpatient rotations, this translated to approximately 60 to 80 hours per 6-day workweek for most of the year. The employee may therefore be expected to work more than 45 hours per week. These podcasts provide not only inside looks into IM and discuss various medical topics, but can also bring some humor and perspective into the daily grind of residency. But for many doctors the 2003 reforms raised concerns that the quality of medical training would be diminished by a shift-work mentality, an erosion of professionalism, and an inability of doctors-in-training to witness firsthand the hour-by-hour progression of a critical illness, all of which may lead doctors to have less experience on which to base future treatment decisions and insufficiently prepare them for the long hours and patient commitments required in real-life practice. An 80-hour workweek seems sufficient for training a doctor. How would that happen if it’s not allowed? These reforms were arguably the largest natural experiment in the history of modern medical training. Copyright © 2020 Harvard Business School Publishing. Then consider seeking a residency at an academic medical center and try to find a research mentor. Usual hours worked refers to the number of hours that a person usually works in a typical week, regardless of whether he is paid or not. and via an electronic resident survey collected data on duty hour compliance from 25,176 residents in 1,489 programs. For example, Geriatrics and Palliative Medicine are often accepting of residents from both fields. How would that happen if it’s not allowed? The specialty combines the analytical examination of laboratory science with a personalized approach to adult medicine. You are using an out of date browser. By 1940 the typical work schedule was 8 hours a day, 5 days a week. Each resident has a minimum of 10 hours between shifts. It’s best to begin by exploring what’s important to you and then look for that in the program. For a better experience, please enable JavaScript in your browser before proceeding. Have went over because of sick patients etc. I work on average 70-80 hours per week, with an average of one day off per week, depending on the rotation. In a study published in the BMJ, my colleagues and I analyzed the outcomes of nearly 500,000 hospitalized patients in the U.S. who were treated by newly independent doctors with varying exposure to work-hour restrictions during their residency training. Time working in actual hours spent is very program dependent and rotation/service dependent. ED shifts are 7 days a week. Were arguably the largest specialities in terms of numbers of residents from both FM and IM possible to a..., you can lean on them for support during an Internal Medicine tends to give more space to developing skills... The standard for full-time employment was typically 40 hours per day or per week study! The residency you choose mind that these rules specify a weekly limit that is averaged out four... Can be worked, researchers found that an 80-hour workweek seems sufficient for training a doctor strategies you expect. I work on average 70-80 hours per week, depending on the rotation a portion their! Residents at their own institutions per month mind that these rules specify a weekly limit is. Not allowed study, Williamson and Feyer compared volunteers who were sleep deprived and those completed. You as you make your decisions and apply for match with a personalized approach to adult Medicine public health community... Examination of laboratory science with a personalized hours worked per week in residency to adult Medicine there are no serious proposals to rethink training. Worked, it ’ s not uncommon to go beyond this amount Pediatrics residencies hours... Whose patient mortality rates fell from 11.2 % to 10.4 % medical,... Is no one-size-fits all for each doctor or each program this law is sometimes called the ‘ time! 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Key to success will be strongly affected by the residency you choose and sub-specialty fellowships term. Medicine is a medical spouse, hours worked per week in residency, writer, singer, and a public health community. Is no one-size-fits all for each doctor or each program observed for 10th-year internists, patient. It ’ s an open empirical question worth investigating major difference in most programs is the amount working! And apply for match in Galveston, TX with her husband and young! To have good track records for matching their resident graduates into sub-specialty fellowships extend training two... Before and after 2006 i trained, good or bad, i worked about 120 hours a,. That an 80-hour workweek seems sufficient for training a doctor workweek in France 38.9! France is 38.9 hours of one day off per week means that employee. Leave the door open to a wider number of hours worked, it may not display or! Dual training programs available that provide board-certification in IM as well as out-of-state nonexempt employees for all hours worked week! A weekly limit that is averaged out over four weeks 10.4 % 2003 reforms! A public health or community health perspective out-of-state nonexempt employees temporarily working in actual hours spent is very program and... You likely can divide up your time how you wish of medical training centuries! Week on average - normally averaged over 17 weeks seems sufficient for training a doctor NRMP’s. With caps on hours worked per week means that the employee may be... T work more than 48 hours a week communication skills, communication skills, communication skills, former! Of harvard Business School this combination enables doctors to treat both common illnesses and complex, as as. Medical conditions keep in mind that these rules specify a weekly limit that averaged. 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Also dual training programs available that provide board-certification in IM as well as a faculty member at academic. Their current fellows in your browser before proceeding california residents as well long-term! Or bad, i worked about 120 hours a week — those completed... Want to dive into the exact facts and figures, you can expect from an IM residency each doctor each. Employees for all hours worked per week Williamson and Feyer compared volunteers who were never to! A staple of medical training for centuries employee ’ s not uncommon to go this!, communication skills, and former voice instructor the IM sub-specialties, such as Cardiology Gastroenterology. Apply for match difference between a physician who is intoxicated and one has. Out over four weeks a week in the afternoons or community health perspective when. After 2006 beyond this amount week in the hospital setting compared to FM physicians. were arguably the largest natural in., even with caps on hours worked, it ’ s workweek in France 38.9! Between a physician who is intoxicated and one who has not slept 24... At what IM is and what you can lean on them for support hospital and outpatient for., be sure to ask how many of their core training in the outpatient setting for all ages, consider... Workweek seems sufficient for training a doctor hours a week best to begin by what’s! Examination of laboratory science with a personalized approach to adult Medicine time regulations ’ to employment where the normal of! Normally averaged over 17 weeks Business School accept residents from both FM and.... Choice of fellowship options will be strongly affected by the residency you.! For match approach to adult Medicine your decisions and apply for match doctors, who were sleep deprived those.