 So this week, as you guys can see, I worked 65 hours as a full-time physician. Now I have no idea if this is too much, too little, or just the right amount for the average amount of hours that a typical doctor works. So let's find out in this video together. Hey guys, welcome back to channel. In case you're new here, my name is Lakshman, internal medicine physician, and here at the journey we help people just like you succeed on their medical journey by doing it with less stress. And today I am interested in about time because I've been putting a lot of it in the hospital. As you guys can see, if I just shared my screen, this is the amount of hours that I've been putting into the hospital last few weeks. So last week, 65, 34, 39, those were clinic weeks, 55, 64, I was on vacation for a week, 27, but then right here, 79, 72, 67. So there's a huge range and honestly, I don't know what's considered to be normal, what's considered to be average. And if I'm working more hours than that, so let's do the research together and hopefully you guys enjoy this video. Now in today's episode, yes, we're going to break down the amount of hours a doctor works, but also the variations that go into that number. And in Hawaii sometimes that number is not exactly correct. We'll get into it. But first let's start with the number one question, which is how much does a typical doctor work? Now if I share my screen again, I found this really nice chart from a 2018 study that was done on about 13,000 physicians. Now these are full-time physicians as well as residents, but as you guys can see, the average was anywhere from about 41 to about 60 hours. So on those weeks that I've been working 65, I'm typically about in the 15% range compared to this data. And there are still about 4% of doctors that are saying that they're working more than 80 hours a week, which is two full-time jobs in a week. Keep in mind after all that year of training. But on the flip side, there's also some doctors about 5%. They're working less than 20 hours. And these are typically going to be your physicians that are working part-time because maybe they choose to or they're late in their career, or they chose to prioritize other things like family. So knowing that the average amount of hours a doctor works is 46 to hours is helpful, but the next question is which doctors tend to be on the higher end and which doctors tend to be on the lower end. And so I found this really interesting article from 2011. Now the way they do it, it's probably not my favorite, but essentially what they do is they go ahead and break how far from deviation of a typical family medicine physician, and this is again 2011, each specialty tends to do. So in the middle, we have places like infectious disease and internal medicine, things that often tend to be a lot heavy on the clinic setting, so it's fairly similar to family medicine practice, versus things like vascular surgery, which can spend anywhere from a thousand hours or more on an annual basis compared to their typical family medicine service. So if you take that thousand and you divide about the 52 weeks, you roughly get an extra 20 extra weeks for a vascular surgeon or somebody who may be in the NICU and neonatal care or thoracic surgery compared to their family medicine colleague. Now also keep in mind that the standard deviation or the length of these lines are pretty broad, so you can have somebody who is in vascular surgery who may only work 500 hours extra or 10 hours per week compared to the family medicine colleague or somebody who's on this side and may work 1200 extra hours on a week, which I'm not really great at math, but I think that equivalates to about 25 to 30 extra hours per week. Again, check me, comment below, show your hate, but that's a lot of hours. Now on the flip side, compared to some of their family medicine colleagues, you can see that specialties in things like dermatology or PM&R or even emergency medicine and psychiatry, keep in mind this was 2011, so some of this has definitely changed. Since then, maybe working 500 less hours and so on average about 10 hours less per week than their family medicine colleagues. And so typically you see a bunch of internal medicine and some of the basic surgery rotations like OP-Gyne and general surgery lit on the higher end and the more surgical and procedural get the higher you are up here and the more to be on a shift schedule, so emergency medicine or on a little bit nicer of a clinic schedule, you tend to work a little bit less hours. Now, so that data by itself is super interesting, but I really want to get into those small nuances of why these hours don't necessarily paint the entire picture. And before we get into that, it's really important to talk about why hours matter in the first place. And that's because while all doctors work a lot, some just tend to work a lot, a lot. And that basically came into fruition in 2003 with the 80 hour work week. And the 80 hour work week is basically a 2003 policy change that was done to protect trainees like me who are a resident, general medicine resident for myself or fellowships. And basically said on average, you cannot work more than 80 hours a week. Prior to that, it was very common for doctors and residents and trainees easily put 100 and 120 hours. And I've sure had my fair share of attendings that said, back on my day, I used to work 120 hours not leave the hospital for like 36 days. I'm not sure what accident that was, but that basically sound word for word of what they had told me. And when this rule came to fruition, there were both people that were proponents of it as well as people who just didn't like it as much. The people who didn't like it argued that you need to be in the hospital and spend more hours to become better at your craft, which there is some truth to it. But on the flip side, the people who were big proponents of the 80 hour work week said that honestly, a doctor tends to be more dangerous in the hospital the more hours they spend, especially when they're fatigued and tired. And I'll get into that in a second, but I've definitely felt in the situations where if I worked a few more hours, I probably wouldn't be that sharp and bright. And I honestly wouldn't trust myself to take care of a patient. Now, while the 80 hour work week came back in 2003, it really has changed the dynamic of medicine because more and more people are focusing on things like lifestyle and the amount of hours you're spending in a specific specialty and residency program compared to something that's very similar. Now that we understand what the upper limit of a work week should be, at least for trainees like myself, let's get into why those numbers are actually not true. First of all, if you focus on an 80 hour work week, you realize that the way the rule is written is says on average over a four week span. That means I could spend two weeks working my tail off and getting 85 or 90 hours, but then working two weeks where maybe I'm getting 70 hours. So on average, I'm at 80 hours. And you could argue that maybe that's still not safe for those two weeks. On the same page, necessarily how those hours are done is also a little bit tricky. For example, at my institution, we have to do 28 hour calls. Now a 28 hour call means that I go to the hospital, for example, tomorrow at 7 a.m. I don't come home until the following day at 11 a.m. That's 28 hours. I spend the night in the hospital and if there's times where I'm on ICU rotation or something that's really busy, I mean I get to sleep very much if at all. So 28 hours of being awake while practicing high level care and medicine is pretty hard. But again, if I get a day or two off within that week and my total time ends up being 72, worked less than 80 hours. And so if you're really interested, I encourage you to read the policy around this 80 hour work week because while it sounds really nice, there are certain ways that residency programs can essentially put you to the max. So for example, it says that a second year resident or a third year resident like myself can't work more than 28 hours. And so we're basically given a max of 28 hours but as many of those shifts that can be included into a residency program are done if your program chooses to do so. As a first year resident, you can't work more than 16 hours but if you allow them to have a 16 hours, you're definitely probably going to have a 16 hour shift here and there again, depending on your institution. And finally as part of that rule and also to keep you within the 80 hours, it says that you cannot be on call or on coverage like I'll be on tomorrow more than every three days. And what most residency programs do, they make it every four days. And so it's still a little bit of resident wellness while still playing super tight to the rule and that gets into part number two which is how true are these hours really reported? The first issue is actually reporting these hours. For me personally, I have to go into a website and actually indicate just like I showed you guys earlier what hours I worked on which day. And as busy as I am, the last thing I want to do when I come home is saying yeah, today I work from like 7.45 to like 9pm. I usually just don't care and I usually come in seven days later and say I work roughly here to here, here to here, here to here. And then sometimes they'll yell at me saying you're at 79 hours or you're at 81 hours and I was like oh, maybe I worked an hour less here or an hour more here. It's very easy for residents to over-report or under-report because often the reporting system that we do is pretty difficult to keep track of. And then two, it's much easier to say we worked less instead of explaining why we worked more. And so you can see how residents like myself may report that we worked 40 to 60 hours a week but that's just because it's easier to under-report. And particularly for specialties like my surgery colleagues, who definitely have had weeks where they worked more than 80 hours, it's just so much easier to under-report and just not acknowledge it versus having to explain to your institution why you're working more hours and also you have to remember that the cost of reporting that you are constantly working more than the 80 hours basically costs the program that you're a part of. And so if that program lose accreditation, you're kind of also screwed. So again, another reason of why one, the quality of hours and two, how easy it is to under-report is a big problem in medicine. And then to finally understanding why these numbers are not really accurate is it's just a big discrepancy of what these hours look like depending on the specialty you're in. So for example, if you're in internal medicine, one of the jobs you can do is a hospitalist where you typically will work seven to seven, seven days in a row. So that's 12 hours times seven, so that's 84 hours. But the flip side is, while that's a lot of hours on one week, the next week, they're completely off. That's usually how most institutions do it. A seven on, seven off, working seven hours for an entire week. On the flip side, you may have somebody who's in emergency medicine that typically will work 12 to 13 shifts and those shifts can be anywhere from nine to 12, 12 plus hours. So again, you can see the discrepancies between the quality of hours because again, you can be an emergency medicine doctor and work a night shift and then your next shift is the afternoon shift. So technically, you've had some time to sleep, but it's not really a viable thing to continue to do regardless of how many days you have off. And as one more example, if you are any type of proceduralist and interventionalist, if you imagine somebody who's a cardiologist who may be on STEMI calls, so if somebody has a heart attack, they have to drive to the hospital. But if they don't go, do those hours necessarily count in these surveys? And the question is, we just don't know because the reporting is so variable in who is reporting and basically the age group. We can include more trainees who have a tendency of under-reporting. And on the flip side, if you're a veteran physician who is out of training, there's really no downside of over-reporting the amount of hours that you're doing, so you're likely going to be more accurate. And because all of this data typically combines both of them, honestly, don't know. But we say, again, somewhere between 40 and 60 hours. But that, guys, is my full breakdown of how many hours a typical doctor works in a week. I'm sure you guys have more questions. What about this specialty or this one? Let me know in the comment section down below which one you want to know. And then do you agree with me? Do you actually think we should be working more than 80 hours, less than 80 hours? Or is the amount of hours that I'm currently working, which is 62.5, and probably will be more this week. Is that just the right amount? I would love to hear y'all's thoughts in the comments down below, so make sure you include them. And if you did enjoy this video in this episode, go ahead and hit that like button. Go ahead and hit that subscribe button. Hit that like button one more time, just in case you haven't. And if you're listening to this on the podcast as an audio version, then consider hitting follow and subscribe on your favorite podcast-listening platform, and also leave an honest review on iTunes. But as always, guys, thank you so much for being a part of my journey. Hopefully, I was a little helped to you guys on yours. If you did enjoy this video, then check out this video on how much the typical doctor makes here in the US, as well as how much money I made as a resident on my first year. I'll be linked over here. And if you guys have any questions, drop in the comment section. But until then, I'll see you guys in the next one. Peace, my friends.