Hours for Junior Doctors

Annemimi

I'm going to be studying medicine next year and I wanted to know about the hours that junior doctors are working at the moment. I've heard several different stories from 'it's not too bad' to 'it's a total nightmare'. I know that they're meant to be reducing junior doctor hours over the next few years but the health service is in such a state I have my doubts about it actually happening.

Anybody out there actually working as a junior doctor at the moment, how bad is it really?

snorlax

iv heard it's about 80-100 hours but i suppose it also depends on who's your consultant/and what hospital your working in..but you'd be better off waiting till someone more in the know then myself posts up here.

what college are you doing med in?

DrIndy

It can be pretty hell. It depends on the service you are attached to and the "take" they have. If you are doing surgery, with a big take then you can be working 7:30am to 10pm on some days just before theatre days. If you are doing medicine, and if you have a big take (which is the amount that are admitted through A&E and handed onto the medical teams) - then you can be very busy too - I am entering very busy week as we try to sort out 25 new patients as well as our previous 15. But then when we clear them out and discharge the crew - you get some down time and work 8-5pm for the next week.

This is the standard days. On top of this is call - and dependent on the call rota can be one day in 9 to one day in 3 or 4. If you work in a larger hospital, then you are on call less as there are more junior doctors and I currently work one night in 9 on call. Call is also varying in busy-ness. You have a realistic expectation to get about 3 hours sleep per night provided you can pair off with another intern and swap bleeps for protected sleep. Surgical teams can be one in 7 and in the smaller hospitals can be up to one in 4.

Combined, working hours are from 60-100 hours per week dependent on the take and the call. My lowest was 60 and my highest was 80 hours. You live in the hospital and just eat lunch and dinner there, only going home to sleep. Its tough, but its fun.

The bad old days of working one night in 3 call all the time and 120 hours per week standard are gone and dusted, however, the implementation of the working time directive is also some time away.

What makes a big difference is an ability to walk fast, eat fast and be efficient - this cuts down a whole load of time.

Annemimi

Ugh how awful! That's pretty much consistent with what everyone has told me, sometimes I think I'm totally mad for doing this!!! :eek: Maybe hours will be a bit better in 5 years time (but I'm not gonna hold my breath.)
Going to Trinity, amazingly it's the cheapest of the colleges in Dublin, paying fees cos this is my second degree. Absolutely can't wait even though I'm a tad worried the hours are gonna kill me when I start working, but hey if you keel over on the brink of death from over-work and sleep deprivation I guess a hospital is the place to do it!

snorlax

Annemimi you'll probably get used to it after a while and will quickly build up a tolerance to all the sleep deprivation/ excessive working hours... and sure don't worry about it yet, you'v still another 5/6 years to go before all that happens so enjoy your years in college and make the best of them

good luck!:)

ps you might bump into me at some stage im in 3rd year in the school of OT in James

ecksor

If I had to endure that sort of sleep deprivation I'd start killing patients that I disliked.

Kevin_rc_ie

if i had to endure that kind of sleep deprivation i couldn't guarantee i wouldn't kill patients by making mistakes due to fatigue.

DrIndy

You develop tolerance to sleep deprivation after a while and just get used to walking around like a zombie. Most people don't actually realise the way we work, including many other staff groups in the hospital. I've had comments from patients as to why I am going around with a two day stubble on me until I explain that its because I've no time to shave......

snorlax

you should watch that film Dawn of the dead....!

people can go nuts, eg they get really paranoid if theyr deprived from sleep for long periods of time, you'd think being doctors you'd be treated decently and given the recommended amount of sleep..

but din't forget theyrs always the leather couches acorss the way if you don't make it back home..:)! and coffee, don't forget the coffee! that coffee shop beside centra had the best coffee in James.... :cool:

Annemimi

DrIndy wrote:

You develop tolerance to sleep deprivation after a while and just get used to walking around like a zombie. Most people don't actually realise the way we work, including many other staff groups in the hospital. I've had comments from patients as to why I am going around with a two day stubble on me until I explain that its because I've no time to shave......

That's actually kinda funny!(sorry ) So are you an intern or have you been working like that for a long time? I have a couple of friends who trained back in the bad old days of 120 hrs a week and one night in three on call, and I've heard many a horror story so I suppose it could be worse......
Right I've got 5 years to get less cranky when sleep deprived,maybe people will be more sypathetic towards me cos i'm old (I'm a supposedly mature student) hope you're not feeling like too much of a Zombie and have had time to shave today......

Annemimi

snorlax wrote:

you should watch that film Dawn of the dead....!

people can go nuts, eg they get really paranoid if theyr deprived from sleep for long periods of time, you'd think being doctors you'd be treated decently and given the recommended amount of sleep..

but din't forget theyrs always the leather couches acorss the way if you don't make it back home..:)! and coffee, don't forget the coffee! that coffee shop beside centra had the best coffee in James.... :cool:

Oh good tip btw, thanks!

DrIndy

Annemimi wrote:

That's actually kinda funny!(sorry ) So are you an intern or have you been working like that for a long time? I have a couple of friends who trained back in the bad old days of 120 hrs a week and one night in three on call, and I've heard many a horror story so I suppose it could be worse......
Right I've got 5 years to get less cranky when sleep deprived,maybe people will be more sypathetic towards me cos i'm old (I'm a supposedly mature student) hope you're not feeling like too much of a Zombie and have had time to shave today......

There's quite a lot of my job that is really funny.

I have a fella who is due up in court soon and he told me this at 16:30 today. I had to rush around like a madman trying to get a cert written up and faxed off to his lawyers to prevent a bench warrant being issued to him. Then I was f'ing and blinding a bit over the phone and told the nurse to tell him that I was going to kill him (jokingly). He was a tad worried looking when I came around until he realised my comments were a joke........

eth0_

hey dr_indy didn't think we'd see you again for 100 hours or something

Kevin_rc_ie

well i just worked 80 hours over the last 7 days. luckily enough i didn't do over time on sunday and had a good rest. my job (obviously not a doctor) requires really sfa attention in the most part. i'm quite tired.

however, as indy says, you get used to it, and as long as you get 6 hours an night and make up on a week day you can survive. however, the important thing is, you have zero life 90% of the week. work, sleep,eat,hour to spare, sleep, work,...

DrIndy

Just got paid, takes the edge off the work!

Its sometimes more quiet. I did 9-5pm today and will probably do the same tomorrow. However, I'm on call this saturday and we are post-take next week so it'll be 12 hours a day for a few days until we clear out the backlog......

ergo

to OP

I seriously doubt the hours problem will be sorted out by the time you graduate, but it should have improved somewhat,

I mean it was only about 5 or 6 years ago that junior docs didn;t even get paid for overtime, at least that has changed

as Indy says, your hours are really related to how often you have to be "on-call" which currently means staying in the hospital after you've finished your ordinary day's work and covering all the on-call stuff (either on the wards or in Emergency) until the following morning when the normal day staff return and, oh yeah, you have to do your normal day job

usually when on-call you should be on-call with another doctor and can potentially share the night and each get 3 or 4 hours sleep

in smaller hospitals you may be the only one on call and could get woken eg at 1am, back to bed at 230 called again at 345 back to bed by 5 called at 640, now that is an extreme example but could lead to sleep-deprivation*-induced craziness in general
*remember sleep-deprivation = torture (see Guantanamo Bay)

I have friends who have been on rotas where they are on 1 in 3 or 1 in 4 and this is not particularly good for the mind or body but havin said all that, sometimes in some hospitals "on call" does not mean being busy and a night's sleep can be got, fairly rarely mind you

basically at the moment there is a group from the UK who have been analysing what doctors are getting called for and actually doing while on call and I suppose in particular what doctors (who still have to work a full day the next day) are getting woken up for, occasionally docs get woken up for ridiculous stuff eg to chart simple meds like paracetamol or to do something which can wait, or they spend half their on call especially at weekends doing bloods which could be done by a phlebotomist

it may mean giving more power to the nurses, eg not to have to wake a doctor immediately to see some drunk guy who shows up in casualty or to send patient on and tell them to come back in the morning to be seen , or the power to give the simple medications and get them signed for later by the doctor without waking them

you may notice in the news the odd time talk about the European Working Time Directive (EWTD), this contained a few nice concepts such as a maximum 58 hour working week or never having to work more than 13 hours in a row

some problems with its implementation include

1. the govt (HSE) wants doctors to change to shift work which a lot of doctors are extremely reluctant to do for reasons such as

a) impact on lifestyle

b) reduced quality of training of juniors by consultants ;basically because the junior may be working the evening/ weekend while consultant (who has to teach the juniors, that is how juniors get trained and get to be consultants, by learning from them) is only on 9 to 5 (in theory often much longer hours)
c) impact on salary, basic pay is not fantastic for doctors eg I think it is €13 or €14 per hour for an intern starting after 6 years in college or about €29,000, update me if I'm wrong so overtime is where the money is made

2. shortage of doctors: there has been no increase in intake into the med schools for past 20 years, manpower crisis looming

I wouldn't let any of the above stop you doing med, you don't even notice the long days if you like what you're doing and get on with the doctors and nurses that you're working with

things can only improve

and if they don't, you can always go to Australia where there is a shortage of doctors also, but their health system otherwise is miles ahead, many jobs there are 40 hours per week maximum (they have accepted shift work into some areas of medicine there) and Irish medical graduates are well respected and warmly welcomed

Kevin_rc_ie

it may mean giving more power to the nurses

I don't think Doctors like to give their power away.

DrIndy

What Abel has written is very clear. The issue of shift work is to boulder in the working time directive in some way or another. I currently work illegally by being on call as Ireland has already passed this into law here. However, it is also an issue of training, many registrars do not get the apportioned study days or opportunities that are required under their respective college of physicians or surgeons regulations for promotions. This is not because of the consultants who support their training, but the hospital manpower departments who won't schedule in the time or hire more staff to cover the shortfall.

My own training is more regulated although leaves much to be desired compared to the UK. The Medical Council controls my training scheme and thus if they are unsatisfied with the level, they pull those intern posts from the hospital and they lose those staff places (hospitals want more interns as we are the "cheapest" level of doctors to hire).

The salary is good, but only on the overtime. We are trained to the equivalent level as accountants are, but our basic salary falls far short.

DrIndy

Kevin_rc_ie wrote:

I don't think Doctors like to give their power away.

Don't mind really - a well trained nurse with their head screwed on is a godsend when you are in a pickle with a very sick patient. The issue is that many nurses are NOT trained the way we are and they need to go through many years of masters and doctorate programs before they reach CNS level (clinical nurse specialist) - then they are fantastic.

When it comes to practical procedures however, things should change - there is no good reason why all nurses cannot place NG tubes, IV lines, male catheters or administer all medicines (provided they have been certified). Ireland is actually driving away nurses because of these archaic regulations....

Anyway, I'm post-call and post take again. We only hoovered up 12 new patients so it will be a settled week next week sorting them out and sending them home. Call last night was good craic too - I had a good partner and we both got about 6 hours sleep through the night. The cameraderie with some of the nurses is excellent and a good boost, a few always bleep with the phrase "I'm REALLY sorry for waking you.... but ...." I always appreciate politeness!

I also assisted in cardioverting a patient who was in a crazy fast heart rhythm - we injected adenosine and wham! heart rate returned to near normal...... it was cool.....

Kevin_rc_ie

The cameraderie with some of the nurses is excellent

ergo

DrIndy wrote:

Don't mind really - a well trained nurse with their head screwed on is a godsend when you are in a pickle with a very sick patient. The issue is that many nurses are NOT trained the way we are

this is true, there is a huge range out there in terms of quality of the nurses , especially at basic grade ward level, at senior level a good nurse can mean a good efficient ward or department or the opposite

DrIndy wrote:

The cameraderie with some of the nurses is excellent .

it doesn't take Einstein to figure out where this is going

there's a quote I love in an Australian book called "Bachelor Kisses" by Nick Earls about intern life

"there are two good ways not to be liked as a resident (intern).

The first, which is both faster and easier is to resent openly any call from nursing staff which is likely to lead to work.

The second is to handle relationships with nursing staff injudiciously.

The obvious trap is that efforts to avoid the first error may be rewarded with opportunities to commit the second..."

love that quote

Annemimi

Thanks for the insights, always good to get the lowdown from those in the know. (As for the comments bout the nurses I guess boys will be boys....... :rolleyes: )