Long Call, Long Haul (part 1)

A three-part series describing the demands of life on the wards … and what you can do about it!

Part 1:  The “life” of an intern

On July 1, 2011 the new ACGME rules on intern duty hours in hospitals took effect. Interns, though not residents, were no longer allowed to work 27-hour shifts as residents everywhere historically had done. The 80-hour work-week still applied, but instead of staying in-house overnight, interns were supposed to have ten full hours away from the hospital between every shift.

Also on July 1, 2011 I started my intern year at Mount Sinai Hospital in New York City. I had done routine 27-hour shifts during medical school, as a fourth year sub-intern in the Cardiac Care Unit (CCU) and as a third year on labor and delivery shifts, a standard part of the OBGYN rotation. And while these were something of a distant memory following a very chilled out fourth year filled with electives and one trip to Africa, I remembered them well enough. The slightly dizzy feeling of walking out of the hospital into the sun at 11am followed by a brief period of sleep-deprivation-induced mania; the great excuse to cram my face with my favorite pastry from the bakery down the street; and the 4-5 hours of slightly nauseated waves of sleep before getting up and having “a day off,” for me usually consisting of a yoga class and dinner before going to bed.

Point being, I had a decent sense of the difference between the demands of the old system’s 24-hour plus shifts as compared to the new system of “night float,”—shifts that last from 5pm to about 7am. At Sinai, two-week stints on night float are interspersed amongst what we call “floors,” i.e. daytime shifts on the inpatient wards that start at 6.30 am when the night teams sign out and go home. Blocks of floors are interspersed with blocks of nights and together they account for most of an intern’s year.

Every residency program’s scheduling is a little different, but the national guidelines are strict and hospital-to-hospital it works out to be about the same. And the reality is, that for intern or resident, in surgery or medicine, from New York to Nevada, any way you slice it, it’s long, and it’s a haul, and by the end of a block you’re exhausted. Sometimes residents complain that we interns have it easier with the new rules but generally everyone agrees that it adds up to be a similar amount of work and hours, just set to a different rhythm. The oases are the outpatient blocks and vacation weeks that allow you to get your sleep cycle back; a sort of stockpiling of energy for the plunge back into the swamp of residency, wading through the days until the next island of sleep comes into view.

How do you stay healthy through this? Ha, great question! I think that whether you are a resident, intern, or med student, it depends ultimately on how you define “healthy” and where you’re starting from health-wise in the first place.  We doctors, as it turns out, are very different people.

For the answer to Robin’s question, tune-in next week for “Part 2: What’s your health-type?”


About the author

Robin Friedlander, MD, graduated from the Columbia University College of Physicians and Surgeons in 2011 and is currently an intern in Internal Medicine at Mount Sinai Hospital in New York City. Robin has been a certified yoga instructor for 6 years and is a proponent of integrative medicine, having recently begun studying Ayurveda with an eye towards incorporating it into her future practice. She also writes about health and wellness, and is a regular contributor to various blogs including MindBodyGreen.com. Follow her on Twitter @robinef.


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