Duty hours won’t improve quality of life. Feeling supported will.


I just finished my first call weekend as an attending. It was a 96-hour bender. I had 4 vaginal deliveries, 1 cesarean, rounded on 20 patients on Saturday (mostly new), 14 on Sunday. I admitted 5, transferred 2 out –one for persistent ventricular tachycardia and one for a possible liver abscess, all while juggling full days of clinic on Friday and Monday.

After the call, I felt tired, but still felt very functional. To be honest, I loved it. It was exactly what I wanted to do when I decided to become a physician. I was probably at the hospital around 55 hours or so, and answered phone calls periodically through the night every night. My longest uninterrupted sleep period was around 3 to 4 hours per night. I had to return around 1 a.m. to further assess a septic patient on one of the nights. All of this was done on a new computer system for me, with all new nurses, in a hospital system that I don’t fully understand.

I didn’t write those numbers to brag. To be honest, it was probably a weekend that the average on-call physician puts in. My point was to emphasize that I was pretty busy. And while it was challenging and difficult, it was nowhere near as exhausting as a 30-hour call during residency. Especially my early calls. I had some deep, dark times early in residency.

So I spent the whole day wondering why early residency is so much more physically and emotionally exhausting. In order to process my thoughts, I probably need to explain a small amount about my residency experience.

I went to an amazing residency. Actually, the word amazing doesn’t even do it justice. It was full of tons of brilliant, supportive physicians. And the other residents in my class were all genuinely good people. They all wanted to help. By the time I was an upper level, I rarely felt alone. I always knew how and where to get help when I needed it. Intern year, however, was vastly different.

Before I knew how amazing my attendings and co-residents were, I often felt very isolated. Those were the dark times. The 3 o’clock in the morning times when you don’t know what to do, and you feel like there’s nobody to help. Those times are the times that make residency stressful. Those times when you feel like you’re the only person on the planet, you have 200 things to do, and nobody is willing to help you. Words cannot describe the emotional weight some of those nights can put on you.

But my residency experience taught me that I’m rarely alone. My mental health is stable because of those incredible people that I knew wanted to help me. I know that there’s always somebody I can talk to — there’s always somebody to help. My first call as an attending went smoothly because people wanted to help me.

Duty hours won’t improve a resident’s quality of life. Feeling supported will. And until we get our acts together as health care providers and support each other, people will get burned out and depressed. And the world will continue to lose wonderful physicians to mental illness and suicide. Resident quality of life isn’t related to duty hours. It is directly dependent upon who that resident is working with — interns, upper levels, attendings, and nurses.

Maybe that’s why my 96-hour bender wasn’t that bad. I guess it’s a whole lot easier working 96 hours as a team than 30 hours by yourself.

Justin Reno is a family physician.

Image credit: Shutterstock.com


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