Is it Sustainable To Work 24/7 Calls As A Doctor For A Week Every Month? #463 Part 2

But this is in medicine . It says how sustainable is 24 seven call for one week per month , procedural ? And it says it seems it seems some procedural fields have a model where attendings are on call one week per month for what I assume is 24-7 . Is this sustainable for an entire career ?

People who have done it in specialties where you're frequently called from home while on call how intolerable is the schedule ? So I will start off by saying this is not how I work . I don't think trauma surgery is like this at all .

When they say procedure , I'm thinking when I see this I think they're talking about like cardiology , interventional radiology , like those type of specialties where you can be home for a significant period of time and then when you get called in , it's really to do a procedure and then go back home .

Then , technically , from you know , once I sign out , which is at seven o'clock in the morning , Tuesday , I'm off . I'm on backup though .

I cannot be more than 15 minutes away , because the person who's doing 24-7 call on Tuesday in the hospital if there's an emergency and emergencies could be like hey , I need to go to the OR and do an appendectomy and a trauma comes in . Then the person who's on backup , which would be me on Tuesday , you got to go

in , I got to come in , I got to be prepared to come in . The likelihood of that happening , though , is low . I can't tell you what the percentage is . But the percentage is less than 20% chance that I may have to come in . So let's say nothing , comes in , I'm just resting .

I'm eating , I'm watching TV , I'm recovering and so forth , but I got to have my phone on right next to me . No-transcript , no duties , no backup for 24 hours or for two weeks . Right , those two weeks were hell . You know it was rough . There could be two weeks where you know when you're on backup . You don't get called at all .

There could be times where you're finishing your call at seven in the morning . So let's say it's Tuesday morning , I'm finishing up from Monday and you know I get an appy that comes in at five in the morning , or I get an appy that comes in at three in the morning . The next question is in your mind is well , who's going to do this appy ?

Who's the best person to do this Appy ? Should it be me , who's just finishing Right ? So now we're talking about operating .

So for me , I work at trauma centers , acute care surgery centers that do 12 hour shifts . You work hard for 12 hours and then tag , the next person takes care of it , so they're fresh enough so that they can still operate . Or if you need to stay a little bit later on , you're like on hour 13 , 14 .

If you need to stay a little bit later on , you're like on hour 13 , 14 , 15 , like you're not exhausted , right , and you can still do an operation if you just don't want the person coming in , the night person , or vice versa , the day person to get screwed . So that's what I do , but 24 hour seven .

I always imagine this for the procedural type folks like the folks who don't have to be in-house all the time right my job , I have to be in-house right , right , except for when you were backup right so like .

That's why I think like the ir docs who like maybe during the daytime they just have regular , normal ir stuff , but at nighttime I just noticed that for like a week straight you know if you got a spleen that needs to be embolized . If you have , you know something that's extravasating that needs to be embolized they come in . And that's tough , but it's .

You know . You always look at it as OK . Can you work hard for a week and then be off Right , Right , it's tough . There's so many different factors to think about this , Like but are you really off for that week Right After that week is done , Right ?

But then when you finish with that week , you may have the weekend off , but then Monday comes and you're not on call , but you're still doing 7 am to 5 pm and you keep going yeah we see that in OB Not so much 24-7 call right , we don't really see OBs on consecutively like that but you might have an OB service that could have you on call two , maybe even

three times I mean , three is excessive , but two or three times a week , you know and then also have weekend call , maybe once a month or maybe twice a month again , depending on how many docs are in your rotation .

of things , pick the kids up from school , and I'm probably already starting to get a little tired , right ? So by Friday evening I'm okay , I'm okay , but there's usually some people on the floor , usually a delivery . That either happens on that Friday or happens early Saturday morning .

Okay , if it's early Saturday morning and when I say early Saturday morning , I'm talking about the ones the 2 o'clock , 3 o'clock in the morning yeah , I start to get a little bit tired , you know . So I might have to put my head down , if I can . I try to put my head down Saturday morning usually .

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Either the patient is laboring or maybe she rules out and she's not in labor , and then I'm able , usually on Saturday , to go back to my hotel room for some period of time whether it's the entire rest of Saturday into Sunday morning , that remains to be seen . By Sunday morning I'm usually back at the hospital , usually rounding .

Maybe I'm doing a delivery in the morning and then finishing up rounding and again just kind of waiting to see if someone's gonna come in . Sometimes we have an induction on Sunday .

They started putting in some of the inductions on Sundays , so I'll start the induction and , depending on how I'm starting the induction , I usually can either rest up in the hospital or I can actually leave and go sleep , and then Monday morning , depending on , again , what's going on , I'm either in the hospital or I'm just signing out and that's it .

But that Monday morning I got to tell you I'm tired .

Right to be able to train in an environment where you know people are actively looking at how long you're working and that if you go past those limits , you get an opportunity to either go home or someone is looking at how well you're studying and so forth . But I'll be very honest with y'all , like that's not the real world .

So that's why I say it's a great environment to learn , but it's not . They're not properly preparing you to work in the actual realistic world and I know that's a controversial take . I'm ready for the smoke , I'm ready for all that stuff .

I think they started the 80 hour work you have to go after how doctors work in the real world to have any type of you know significant change . Like to me , it's just the same thing , like you're putting lipstick on a pig Right by training residents . You know , you guys know what I'm talking about .

These , these surveys by Medscape and so far you know , you'll see things like repeating things over weeks and weeks of these type of call . Like you have increased chances of burnout and depression , right . Sleep debt and circadian misalignment , right . So basically , like you , you're not sleeping at night when you should , right .

As a matter of fact , you're just like you're getting your quote-unquote second wind , and like that just means like you're just not getting enough sleep right right . Um , there's also safety risks that we just got to be honest about it , so it's just something in your car being really , really tired .

But two , it , you also have to kind of look at when you're working . That right , we talked about circadian cycles and so when you're thinking about working night shift or you are working , you know regular during the week or during the day , the regular shifts during the day .

But then you come back on a I don't know , on a Saturday or a Thursday or whatever it is , and you come back on a I don't know , on a Saturday or Thursday or whatever it is , and you have to work 24 hours , a 24-hour shift , right Now , you're kind of thrown off , right .

And so I remember , oh man , I remember this one time in residency I was so tired , I kid you not . I remember I was on Route 1 and I fell asleep at the light . Yeah , I fell asleep at the light .

These are the things that you have to start thinking about . Is it really worth it to get that additional 100K ? Is it really worth it to get you know , whatever it may be in terms of money , if it means that you are possibly sacrificing your physical wellbeing , your mental wellbeing ?

So one thing that I would say is you know when you're seeing if you're going into a position , if you're going into a job , and you see that this is a possibility where you may have to do a week of 24-7 call , but you know during the daytime you still have to do your regularly scheduled stuff . Or when that call is over Monday , you're back on .

Right , like you

have to make sure that . You consider , like man , maybe I should really force , not income , but really force that I get protected post time time , post call , time off . Right , like yo , you're going to give me like 72 hours to recover if I do 24 hours .

If , listen , guys , I'm not saying whatever , you need a day , 24 hours , 48 hours , whatever it may be Right , because if you're telling them , listen , like , look , I'll take 50K less , but I'm just I'm making sure that I get two days off protected .

That might be , that might be everything Right , that might save your marriage , that might , you know , decrease the amount of strain that you're putting on yourself and prolong your life you know , nobody can ever exponentially nobody can ever tell .

Now you're up because you took in caffeine , you took in an energy drink when you could be sleeping , and now when it's time to sleep during the daytime , you're kind of you're off , you know . So limiting caffeine to early hours is good .

And then the other thing too this goes back to contract and just seeing how places look when you're interviewing them Team based coverage to prevent overloading one individual is huge right .

So at my facility or the facilities that I work at , like there's some locums positions that I look at now that say hey , like you know , when you're one person on , you're handling trauma , you're handling general surgery and you're handling critical care , and I'm like well , how long am I doing that for ? Well , we need you to do it for 72 hours .

Click , don't pass go .

So for me I prefer , you know , for 12 hours I can cover trauma , I can cover general surgery , I can cover critical care and if I need to transfer people out , I have that option . Like these are things that you have to consider and these are things that I would recommend is look for places , particularly when you guys just first get out right .

Look for places that have team-based coverage . That's what you're looking for , but it may not be like that for every specialty . I know maybe ob may not be like that and ir . You know they can't afford to have like two ir people at the same time or cardiology , but just something to think about money and everything , man .

but what you're talking about is scope of work yeah right is essentially what you're talking about .

So for OB , for example , right , you guys , in a trauma world , you have you know level one , level two , level three , right , you mean for trauma activation , for trauma activations , right , like the higher , the lower , the level the more you know you should be , the more resources are available .

Exactly , which means the busier you're probably going to be , whereas it's kind of the same thing with OB , except we go down right . So the higher the level for NICU , right , the busier that we are more likely going to be , because the NICU will kind of determine what the OB service is going to be .

And so you have to kind of determine well , do I want to be at a level three NICU hospital , if you're , you know , if you're doing OB ? Do I want to be at a level one , you know , or nursery , you know , newborn nursery hospital when it comes to OB ? And so you have to kind of just think about those things . Do you want to work office , do you think ?

Well , I kind of thought about that with level one versus level two . I was like I'm kind of burnt out from the level one system . I'd like to be at level twos yeah and so forth .

That was as far as I went , but I think what you just mentioned is really important , where you're saying like yeah , like I , there's certain types of nico's , which means there's only there's only a certain level of sick type babies that I want to deal with or complicated pregnancies I want to deal with can you talk ?

So it's not just labor and delivery , it's mothers who have not and are not yet ready to deliver , and you're probably going to have a whole floor full of those women , right , that you now have to take care of . And so if they're having complications in their pregnancies , you have to now determine like , oh well , should I deliver her ?

Should I not deliver her ? Like , you have to kind of go through this kind of rigmarole and always think about the risks and benefits of either delivering this woman or not delivering this woman , and a lot of times you're going to transfer them over to labor and delivery , thinking , okay , this is it , we're going to deliver her . And the next unit ?

She doesn't do anything . And you're like all right , well , transfer her back . And the next unit , she doesn't do anything . You're like , all right , well , transfer her back to the floor because she doesn't look like she's going to deliver . Oh wait , it looks like she's going to deliver again .

I like working with residents , but it just so happened that most of the places that I was at had PAs . I love working with residents .

Just know that you know very there's a lot of things that you're going to take from residency , that you're going to apply right the knowledge wise .

But in terms of the environment that doesn't necessarily have to go with you , particularly if the environment that you are working in is something that you don't like you don't necessarily have to replicate it just because you know , you did it in residency . You can actually avoid that stuff .

You can say well , I was in a big academic center , I like my first job to be at a community based . Or I don't want to work with residents , or I don't want to work with you know . Whoever Right or I am , you know , I don't want to have to take call .

Yeah , I want to doing what it is that you actually like to do , by saying , oh well , but you know what ? If you don't ever do X , y and Z , again it's like , well , I don't like doing it , so what's the big deal ?

You know , if I don't like doing something , then I should have the right not to do that thing , right , because there is value in doing other things that you like . One in the main value .

I don't know about you , but the main value is you become very good at the things that you actually like to do , right , you become kind of the master of one , right , and so I think that there's something to be said for that If you're pushing yourself to do something . I think attending should be pushing to be said for that .

Yep , we see that in trauma , actually , like any place that wants to start a trauma center , you'll see that there's a significant amount of people at a hospital that are usually resisting the transition from a hospital becoming a trauma hospital . And they'll tell you bro , I came here to avoid this stuff .

I don't want to deal with level one stuff I don't want to deal with level two stuff . I just want to take care of people . I don't want to have to have to make like like , for example , like a lot of you know , with trauma in critical care you have to like the amount of echocardiograms that get ordered like , exponentially increase .

So now the people who read it are cardiologists , right . So now they are having to read echoes in the middle of the night or during the daytime and they're like look , man , like the way how it was before you guys got here was you know , an echo was only ordered by my service and we only ordered maybe five echoes a week .

Now , all of a sudden we're up to like 30 echoes . Some of them are stat , some of them need to be read , like at two o'clock in the morning and guess what you know . So it's just one thing to consider . Is guys like money ain't everything .

But I say put the money last because a lot of times when you put the money first , you make that so important to you that you forget to look at all those other things .

, this is what comes , along with the $1 million . And you're going to be like but I looked at that $1 million first , so now it's hard to go backwards . Exactly , but if you look at this and be like . You want me to work 30 days , for how Like I ain't doing none ? Of that I ain't doing that .

Like most people are like extremely happy at 75k , right , but this must have been like 20 years ago because yo the way the price of the eggs tariffs .

But once you get past that point right , once you start going into 100k , 200k , 300k and well into you know where we're talking about seven figures like the level of the , the amount of activity that people have like dramatically decreases because , yeah , they have all that money , gotta earn it .

But you gotta earn it and a lot of times that may involve giving up weekends . Um , giving it giving up something that you may want to do with your family going to a vacation . Earn it um , whatever it may be , you know , earn it and that's when you're going to do with your family going to a vacation , earn it , whatever it may be . You know earn it .

And that's when you're going to be at work all the time , and then that's when you will have to have a work husband or a work wife .

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