I'm now a nearly two months into internship and what a ride it's been so far. My program is better than most when it comes to hours, but my longest shift thus far was 33 hours. We have a night float system, but we still do 24 hour calls occasionally. The ACGME rules allow for the extra 6 hours for transfer of patient care, bringing the total to 24 + 6 (or 30) but my program supposedly abides by a 24 + 3 rule. In other words- 27. It's like they think we won't realize we're working more than 24 hours if instead of saying that the shifts are 27 or 30 hours, they say "24+3" or "24 + 6." Managing my medication on long calls is tough, and I have to make sure I don't flip into hypomania so I HAVE to take my evening dose of Seroquel, even if I'm going to be staying up all night. I take less of a dose, and make sure I get sleep when I return home. So far, so good. No hypomania. Just exhaustion- like all the other interns.
I keep my illness a secret from other people- sneaking pills from inside my Coach wristlet- and I don't think anyone I work with now would ever guess in a million years that I'm hiding something. If you met me now, you'd have no idea. It's nice to be out of medical school because my hospitalization is now a nearly three years in the past. I just tell my peers that I did a research year if it comes up that I was in medical school for 5 years. Of course when I was interviewing, I didn't lie- when asked I said I was on medical leave and then did research. But now, there's no reason to discuss this with my new friends. I just say research year, leave it at that, and I don't have to answer uncomfortable questions anymore.
It's great- sure I do struggle- but I'm so happy to have made it. Sure, there are sucky parts of internship. I had a 24 hour call last night and a nurse called me at 2:30 am to say the BP was 180/80 when it had been that way all day. But, despite these annoyances, I don't regret going to medical school.
Showing posts with label residency. Show all posts
Showing posts with label residency. Show all posts
Thursday, August 26, 2010
Saturday, May 1, 2010
DONE!
Yup, I am officially DONE with medical school. My graduation is in mid-May but in my mind I've already finished- yesterday was my last "working" day of med school.
I'm headed off to internship in a little over a month which is a scary thought. I matched into my top choice advanced program and one of my top choice prelim programs. To those of you reading the blog who aren't familiar with this terminology- "Internship" is the first year of residency which lasts from 3 (ie Internal medicine/ Family Practice) to 7 (ie neurosurgery) years. In "categorical" programs, internship is included, whereas in "advanced programs" it isn't, meaning, as in my case, you have to apply separately for a Preliminary year. Radiology, Ophthalmology, Anesthesiology, Neurology, Dermatology, etc, are examples of programs that sometimes require a separate intern year.
It sucks because I have to move twice- but I'm happy with where I matched so it's worth it.
I had to take my illness into account when formulating my match list. Mania, or in my case, hypomania, can actually be triggered by lack of sleep. And, being that it is perfectly legal to work 30 hours in a row, take 10 hours off, and do the same thing again, I had to pick programs with more humane work schedules. Now what I described is rather extreme- the maximum allowed shift is actually 24 hours, but then you're allowed 6 hours (in some places it's 3) for tying up loose ends, etc. People refer to this as "24 + 6" but I'm like, "whatever, it's 30." One program I looked at basically informed applicants that interns who go over hours do so because they are inefficient. That, to me, implied that interns' time sheets likely have them working < 80 hours with no more than 24+6 in a row, while the actual interns are in the hospital longer than that. I didn't rank the program.
There are programs that have a "night float" system which means that there is, as it sounds, a night shift. This means fewer 24 hour shifts for residents. Even thought night float can turn your schedule upside down and mess up your circadian rhythms, I found this to be preferable to a program where I'd be required to work "24 +6" on a regular basis. Both my intern and residency programs have night float.
I also had to think of the prescription drug plans available. I don't see a psychiatrist a lot anymore- it is basically just for crises and medication management- BUT I do take very expensive medications. Seroquel is the worst offender. I REALLY LIKED one prelim program, but had to rank it very low on my list because the prescription coverage was 400 dollars a year. (!!) And, residents had the same health coverage as one of the hospital unions. So much for collective bargaining!
I'm excited about moving on, but also a little sad because I'm leaving the house I've lived in for 4 years. I'll miss my roommates.
I'm headed off to internship in a little over a month which is a scary thought. I matched into my top choice advanced program and one of my top choice prelim programs. To those of you reading the blog who aren't familiar with this terminology- "Internship" is the first year of residency which lasts from 3 (ie Internal medicine/ Family Practice) to 7 (ie neurosurgery) years. In "categorical" programs, internship is included, whereas in "advanced programs" it isn't, meaning, as in my case, you have to apply separately for a Preliminary year. Radiology, Ophthalmology, Anesthesiology, Neurology, Dermatology, etc, are examples of programs that sometimes require a separate intern year.
It sucks because I have to move twice- but I'm happy with where I matched so it's worth it.
I had to take my illness into account when formulating my match list. Mania, or in my case, hypomania, can actually be triggered by lack of sleep. And, being that it is perfectly legal to work 30 hours in a row, take 10 hours off, and do the same thing again, I had to pick programs with more humane work schedules. Now what I described is rather extreme- the maximum allowed shift is actually 24 hours, but then you're allowed 6 hours (in some places it's 3) for tying up loose ends, etc. People refer to this as "24 + 6" but I'm like, "whatever, it's 30." One program I looked at basically informed applicants that interns who go over hours do so because they are inefficient. That, to me, implied that interns' time sheets likely have them working < 80 hours with no more than 24+6 in a row, while the actual interns are in the hospital longer than that. I didn't rank the program.
There are programs that have a "night float" system which means that there is, as it sounds, a night shift. This means fewer 24 hour shifts for residents. Even thought night float can turn your schedule upside down and mess up your circadian rhythms, I found this to be preferable to a program where I'd be required to work "24 +6" on a regular basis. Both my intern and residency programs have night float.
I also had to think of the prescription drug plans available. I don't see a psychiatrist a lot anymore- it is basically just for crises and medication management- BUT I do take very expensive medications. Seroquel is the worst offender. I REALLY LIKED one prelim program, but had to rank it very low on my list because the prescription coverage was 400 dollars a year. (!!) And, residents had the same health coverage as one of the hospital unions. So much for collective bargaining!
I'm excited about moving on, but also a little sad because I'm leaving the house I've lived in for 4 years. I'll miss my roommates.
Saturday, November 22, 2008
80 Hour Workweeks
"Well, I start work at 6 am so I get tired early," I said to the grocery store clerk, who had just commented on my yawning.
"So, what, you get out at 2?"
"No..."
An 8 hour, or even a 10 hour day has become a luxury. I forget how it is outside of medicine sometimes. There are reminders, though. When I exclaimed that medical students can now get to the hospital later, now at 6 am, my parents, unfamiliar with the world of medicine, didn't really understand how that could be "late" to start work. They also don't understand that a shift may last 24 hours. That people who shouldn't be on the road driving a car, are in the hospital working with desperately ill patients. And they don't understand that this is an improvement.
Resident physicians in hospitals are now legally limited to 80 hours per week of work. There are other stipulations, making 36 hour shifts illegal, and ensuring that there is a reasonable amount of time between shifts so doctors don't have two hours to come home, shower and change scrubs, and return to the hospital.
Many attribute the changes to the Libby Zion case. I don't know many of the specifics of the case- but the gyst is that a young woman named Libby Zion went to the emergency room at a New York hospital and was given medication which interacted with a medication she was on, or an illegal drug she'd been taking- I'm actually not even sure why she went to the ED in the first place, actually. But, anyway, she went to the ED, there were some over-sights, and she ultimately passed away. It turns out that her father's a journalist, so the case gained wide recognition. The mistakes and oversights that were made in the ED were eventually blamed on sleep deprivation and long work hours for residents.
Some seasoned Attending physicians look at that case and dismiss Libby Zion as a cocaine addict who has somehow lead to the ruin of modern medicine, but I think, all things considered, that the diminished work week has been a good thing.
There are arguments against it- some argue that by decreasing hours from 120 to 80, interns have now been cheated out of 40 hours per week of learning and others argue that increased patient pass-offs between residents increase mistakes. Those who protest hours regulations don't like to mention the effects of sleep deprivation upon the doctors, patients, or upon those unfortunate enough to be on the roads while fatigued residents are driving home.
But, whatever the root cause, or whatever the arguments are against hours regulations, I am reaping the benefit and am lucky enough to be entering medicine at a time where there is at least an acknowledgement that long hours are bad.
"So, what, you get out at 2?"
"No..."
An 8 hour, or even a 10 hour day has become a luxury. I forget how it is outside of medicine sometimes. There are reminders, though. When I exclaimed that medical students can now get to the hospital later, now at 6 am, my parents, unfamiliar with the world of medicine, didn't really understand how that could be "late" to start work. They also don't understand that a shift may last 24 hours. That people who shouldn't be on the road driving a car, are in the hospital working with desperately ill patients. And they don't understand that this is an improvement.
Resident physicians in hospitals are now legally limited to 80 hours per week of work. There are other stipulations, making 36 hour shifts illegal, and ensuring that there is a reasonable amount of time between shifts so doctors don't have two hours to come home, shower and change scrubs, and return to the hospital.
Many attribute the changes to the Libby Zion case. I don't know many of the specifics of the case- but the gyst is that a young woman named Libby Zion went to the emergency room at a New York hospital and was given medication which interacted with a medication she was on, or an illegal drug she'd been taking- I'm actually not even sure why she went to the ED in the first place, actually. But, anyway, she went to the ED, there were some over-sights, and she ultimately passed away. It turns out that her father's a journalist, so the case gained wide recognition. The mistakes and oversights that were made in the ED were eventually blamed on sleep deprivation and long work hours for residents.
Some seasoned Attending physicians look at that case and dismiss Libby Zion as a cocaine addict who has somehow lead to the ruin of modern medicine, but I think, all things considered, that the diminished work week has been a good thing.
There are arguments against it- some argue that by decreasing hours from 120 to 80, interns have now been cheated out of 40 hours per week of learning and others argue that increased patient pass-offs between residents increase mistakes. Those who protest hours regulations don't like to mention the effects of sleep deprivation upon the doctors, patients, or upon those unfortunate enough to be on the roads while fatigued residents are driving home.
But, whatever the root cause, or whatever the arguments are against hours regulations, I am reaping the benefit and am lucky enough to be entering medicine at a time where there is at least an acknowledgement that long hours are bad.
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