 What is up, YouTube? Welcome back to my channel. For those of you who are new to my channel, my name is Michael, aka Dr. Jolini, and I am a fifth year resident specializing in interventional radiology. It's been about two months since I posted my last 96 hour call shift video, which if you haven't seen, you can link up right here or hit the link in the description. And since that video, the comments have been blowing up on YouTube and in my DMs on Instagram, asking why I get no sleep, why residents are expected to do so much on such little sleep, and how can doctors overall function on such little sleep? So on today's video, we are going to do a deep dive and find out exactly why doctors are notoriously overworked and sleep deprived. So let's get into it. This video is sponsored by Motivate MD. 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So do yourself a favor, click the link in my description below, go visit the Motivate MD website and use my code Chalini20 to get 20% off of everything we talked about and so much more. Go check out their website today and use my code Chalini20. Now let's get back to the video. Now in order to figure out this whole lack of sleep issue amongst doctors, I think we need to go back to the beginning, which is med school. And after all, med school is the first time where you kind of figure out how to function off of little sleep. The first two years of med school are also called pre-clinical years, and it's where you spend two years studying insane amount of material every single day. Now in these first two years of med school, massive amounts of information fly at you and you have to keep up or you'll end up drowning on these seemingly enormous exams at the end of every two weeks or so. So if there aren't enough hours in the day, what would a med student do? Well, it's easy. They just start by sacrificing sleep. What any normal student would do. Many med students will consistently pull all-nighters in the weeks leading up to a test and it's almost necessary at times to get through the amount of information that's thrown at you. I personally chose to go to bed on time each night, but I would wake up around 4.30 or 5 a.m. to start studying every day. So either way you look at it, you still end up losing sleep. And once you finally finish your first two years of med school, you're finally free and you get to go in the hospital and go on many different rotations of a ton of different specialties. And in order to match into a good residency, you need to have high marks on these hospital rotations. And in order to get the honors passed for these rotations, you have to go into the hospital early, work extremely hard throughout the day and leave late. And you guessed it, you will inevitably sacrifice sleep doing this. Especially when you're on a surgical rotation. Imagine waking up around 3.30 or 4 a.m., sometimes earlier, pre-rounding on all the patients so you know what's going on eventually when the resident's in the attending round in the morning. Then going to the OR all day, standing on your feet, holding a retractor till sometimes later on in the afternoon or early evening. And then waking up and doing it all over again. And this goes on for at least four to six weeks. The interesting thing about med school is that there are no worked hour restrictions like there are in residency, which means you can work as much as you want and no one will tell you otherwise. Into most physicians who are handling these evaluations at the end of a rotation, more hours worked equals hard worker, which equals a great student, which means honors pass. You kind of get the gist. Basically what I'm trying to say is you have to sacrifice sleep in your clinical rotations as well. Are you sensing a common theme here? And then finally you graduate those grueling four years of med school and you're finally a physician, which means you can relax, right? Wrong. Now you have to spend the next three to seven years in residency, which is far and away the hardest part of your medical training. And it begins with your first year of residency also known as internship or intern year. Intern year is specific for what specialty you go into. For example, I have the option of doing surgery or medicine as my intern year. And I chose surgery because yeah, let's just leave it at that. In my surgery internship, I worked six days a week, 6 a.m. to 6 p.m. With the exception of three weeks vacation that I had throughout the year, I worked every single weekend. That's 49 out of 52 weekends. That's 49 out of 52 weeks working 72 plus hour weeks as the lowest level physician in the hospital. Which means you're writing all the notes, fielding all of the pages, writing all of the prescriptions, discharge summaries, and you're the first person on the scene when a patient starts doing poorly. Now make no mistake, this is the hardest year of residency because it's your first time kind of coming into the hospital and learning everything all at once. But it's essentially like a rite of passage in becoming a physician. Okay, yeah, yeah, yeah, Michael. But how does that relate to sleep? Well, the one thing I left out is that intern year is the first time in your career that you start doing overnight shifts. I did two one month blocks of night flow during my intern year working 6 p.m. to 6 a.m. I actually like these shifts because things are much slower paced at night and most of your patients are sleeping, but you kind of feel like a zombie while you're at work. Now your body actually does eventually respond to being on a night shift schedule, but it takes around a few weeks to get adjusted and that's about the time where you switched back over to day shifts. And yes, sometimes overnight we would actually get to get some sleep, but it was interrupted sleep, which means every time I laid down my pager would keep going off and sometimes we could go to the call room, but let me see if I can find a picture of our call room and you'll see exactly why I didn't go there very often because it looks kind of like a prison cell. Now let's talk about the rest of residency, which is about three to seven years in most situations. My residency is actually six years long and for example, a neurosurgery is seven years long. It depends on the specialty. Now residency is pretty similar to intern year, but it definitely varies among specialties. Some surgery specialties have it far worse than say dermatology or even diagnostic radiology, for instance. Luckily though, in the US we have an 80 hour work week restriction policy, which I went into more in depth on this video, which I'll link up here in the description. Now most residencies are set up the same way, which means the more years spent in residency, the more senior you become and the more responsibility you are given or expected. So for example, in my specialty, the third through fifth years you are the most senior resident and you take the most call, which means now that I'm a fifth year resident or a junior fellow in interventional radiology, I take fellow call, which means I'm on call every four nights for 24 hour period and usually about one in four weekends on call. So how much sleep do I get on call? Well, in short, it completely depends on the night. So let me back up a little bit. When I'm on call it's from 7 a.m. in the morning through 7 a.m. the following morning. So when I get into the hospital in the morning I'm usually just going about my normal day doing procedures and I usually am done around six ish or maybe like seven at the latest. Sometimes or usually there's a late case which goes on until like eight or nine and sometimes an emergent case after that. But then I get to go home and I don't have to come back into the hospital unless I get an emergent page, which makes me come back in. Otherwise I'm just at home sleeping. Now home call is so much better than staying in a hospital and sleeping here all night and waiting for a page to come in but it's still interrupted sleep because even though I may not get called in I still get paged about stuff all the time. So we may have a person bleeding that stable that they still call me about and maybe give me a heads up on or I may have a patient that's actually bleeding and becoming unstable and I'm trending the labs all night. So just because I'm taking home call doesn't mean I just get to rest peacefully all night. And the crazy part about being called in in the middle of the night is that regardless of how tired you are your body will somehow adapt and allow you to complete the task that you need to do and stay focused on the procedure or even a difficult surgery if you have to. I really can't explain it. You can just kind of focus. Now it's not the part about waking up in the middle of the night that actually wears you out. It's the fact that after you come into the hospital in the middle of the night you still have an entire day ahead of you which you can imagine would be pretty exhausting especially if you have procedures or surgeries playing that whole day. Oh and PS this is my call setup when I take diagnostic call. It's pretty inviting. Coffee pillow, so comfortable. So the real question we have here is why is training so difficult? Why are doctors so overworked and why are we so sleep deprived because of it? Well, I think a lot of it is actually generational. I think part of it is that they feel like we should experience the same kind of training that they did and experience the grueling long shifts and stay in the hospital for days at a time. The thought of taking vacation back then was kind of comical. You were expected to be in the hospital and learn your craft and stay there for as many days as it took to become the best doctor you needed to be. But eventually we realized something that doctors are human too and we need our sleep just as much as the next person. Sleep used to be a sign of weakness amongst the medical community and now it's a necessity. And because of all this new information the tide has slowly been turning which is why we implemented this 80 hour work week restriction policy So do I personally think it's okay for doctors to come in the middle of night and do an emergent procedure or an emergent surgery? Well, yeah, I do because I mean somebody has to, right? There really isn't another option. There aren't enough physicians in America to have one at every hospital in the US working an overnight shift and you have to realize that's kind of expensive to have a physician in house overnight because after all the rate at which you come in overnight for me personally, for interventional radiology is around 20% which means all the time that I take call I only come in about 20% of the time. The other times I may stay up and answer a few phone calls overnight but I don't actually come in the hospital which means I don't actually perform a procedure which means for a physician that they would be paying to cover the hospital overnight for any emergencies that come in it would be kind of a waste and the hospital wouldn't be getting their money's worth which as we all know at the end of the day hospitals are businesses too. Now of course I wish I didn't have to come in in the middle of the night and I wish I had a more laid back schedule but I also couldn't see myself doing anything else. Every doctor knows what they're getting into before they start residency so for me it wasn't any different. I chose this avenue, I chose this specialty because it's what I enjoy and it's what I love doing. So that concludes this video I hope you guys enjoyed it it's a little different than usual make sure you smash that like and subscribe button follow me on Instagram right here if you have any questions leave them in the comments below and I will try to answer them otherwise I'll see you guys on the next video.