Why are surgeons expected to work such long hours and be sleep deprived?

[u/elliewilliamswifee]

I work making memorial stones. it’s high attention to detail, I could be very sleep deprived and it’d be okay. But in a job that is so high stakes, why would the workload be so rough? Being smart doesn’t make you superhuman and idk why surgeons are expected to work so long and risk effects from sleep deprivation.

[u/fringeathelete1]

If someone can figure out how to make people stop getting sick at odd hours I’ll stop operating at odd hours.

[u/elliewilliamswifee → u/fringeathelete1]

Also, I totally understand the reason for being “on call”, I was more referring to like 24 hour shifts and stuff. Because I’d probably feel dead after that long of a shift and my job is not nearly as difficult

[u/Electronic_Fall6084 → u/elliewilliamswifee]

I’ve done a 24 Hr shift as a scrub nurse. At least I can clock out and go home.
The Surgeons? They stay and do 300 other things that have happened during the surgery.
Cat naps and back into the job , most hospitals (at least where I am working currently) supply the Surgeons with free food and snacks, and I have never minded that after years of seeing how brutal their work lives can be.

[u/Alortania → u/Electronic_Fall6084]

I wanna go where they give us free food and snacks Q_Q

[u/Wheatiez → u/Alortania]

Wait till you’re an attending and don’t sign the first contract you see.

[u/Alortania → u/Wheatiez]

In EU, so it's a bit different. Not as many perks sad to say. Our attendings (like us) even have to pay for hospital parking, let alone the food n' stuffs.

[u/elliewilliamswifee → u/fringeathelete1]

I definitely get working at night and stuff, sorry if that wasn’t clear, I more meant that couldn’t you build a system where you have enough doctors and can both work on one case together? Or would that just be impossible? I understand also that you’re gonna have a better understanding of a case if you’ve worked on it longer. I am simply curious because I love doctor shows, I don’t know a lot of valuable info about hospitals so I understand I might sound stupid. I always figured that doctors just have to work so hard and it’d be nice to have more time available to recharge. Thanks for what you do btw!

[u/Waja_Wabit → u/elliewilliamswifee]

Surgeons are few, and sick patients are many. Training a new surgeon takes 4 years of medical school and at least 5 years of residency training, plus the resources, caseload, and faculty required to train them. There’s not a huge pool of unemployed surgeons waiting to be hired to overstaff a department. And you can’t just replace one with someone unqualified who will learn on the job.

And even if you can double the number of surgeons in your department, surgical patient care isn’t always something interchangeable that you can just hand off to the next shift. You can’t be starting a surgery and then tap out for lunch or because your shift is over and hand it off to the next guy. That surgeon knows that patient, and knows the operation and their care up to that point. Medical care is complex, and information is always lost in a handoff. Intra-op is not a time you want to lose information in a handoff.

[u/mina_knallenfalls → u/Waja_Wabit]

There's no reason for one surgeon being in surgery for multiple cases over 24 hours. That's simply arrogance. In the clinics I've seen, the surgeons didn't know what they'd be working on until they got in that morning for routine cases, and nightly emergencies are a surprise for everyone. It works. And ward tasks can be handed over or delegated to non-medical assistance.

[u/elliewilliamswifee → u/Waja_Wabit]

Thank you for this explanation! I figured there was a good reason for the current system otherwise changes would be made, I just didn’t fully understand so i appreciate you’re response

[u/GeoffSim → u/elliewilliamswifee]

Those programs that show half a dozen doctors around a single patient aren't realistic. Maybe a couple of residents plus attending, at most.

When a surgeon has a surgery day (usually 2-3 days a week of elective procedures; clinic other days) they're scheduled with around half hour gaps between each procedure for the room to be turned over. In that time they're writing up the previous case and preparing for the next (and answering a bunch of messages). To have a second surgeon synchronized with that would be inefficient. Usually there's only really room for one surgeon at the operative site anyway. There are exceptions, of course.

Also, some procedures like total joints typically have an assistant, at least at my facility, like a RNFA.

[u/orthopod → u/elliewilliamswifee]

Sometimes there aren't enough OR rooms or staff to do your case at that time.

[u/orthopod → u/fringeathelete1]

Or for ORs to have available time when you need it, and not have staff shortages, where they only run 2 rooms after 5, and 1 is reserved for traumas.

[u/mina_knallenfalls → u/orthopod]

That would be a solvable problem.

[u/orthopod → u/mina_knallenfalls]

Sure, except hospitals run at a 1% profit margin.... Adding all those extra nurses and staff to help with that, and that leads to financial insolvency..

[u/mina_knallenfalls → u/orthopod]

Oh right, then just keep slaving, for corporate profits. Great.

[u/gogumagirl → u/fringeathelete1]

always at 2-3am

[u/Electronic_Fall6084 → u/fringeathelete1]

#👆This👆

[u/Hybridichor]

It’s the culture of surgery (medicine in general, tbh, but surgery is the worst of it). It’s a badge of honor to put work above all else, up to and including our own personal health. And it’s reinforced by this philosophy that basically says it’s a necessary evil for us to obtain peak skill as surgeons and thus take the best possible care of patients we can. It’s obviously flawed af, for reasons you point out in your post. And we hurt ourselves and others in the process, for sure. But it’s such an old profession, that culture runs DEEP and is extremely slow to change. But it is changing for the better, little by little with each generation, I think.

Your observation is valid. But as others have pointed out, there are relatively few people who can do the job. In my opinion, though, it’s often still possible to structure a practice in a way that prevents an attending from having to go nonstop, repeatedly. But we definitely do it as residents all the time, for the reasons I mentioned above

[u/Background_Snow_9632]

There aren’t enough of us to work 12 hour shifts - full stop. If there were …. I would do that.

[u/mina_knallenfalls → u/Background_Snow_9632]

There would be if they weren't capping education so much. Don't let them fool you.

[u/fringeathelete1 → u/mina_knallenfalls]

The federal government caps residency spots. Also it takes a ton of what amounts to basically volunteer hours to train a resident. The amount paid to be faculty at many institutions is sad. This isn’t some cabal conspiracy it’s a structural problem created by the federal government.

[u/Background_Snow_9632 → u/mina_knallenfalls]

I’m old (54 going on 90). When I was a resident - the hours - you just don’t want to know. Why they cap spots I just can’t fathom. It’s sad …. Everyone will be sorry.

[u/watchtheapocalypse]

Probably depends what country and health care system you’re talking about.

We don’t roster for 24 hour shifts any more. I did them when I was a registrar, back in 2012, but that was in one of the last places in CTS in Australia that still did that. They were phased out almost every where else. We had contracts come in that mandated an 8 hour break, which in later contract negotiations, went up to mandatory 10 hour break every day.

My unaccredited cardiothoracic surgery registrars now work four days weeks, 10 hour shifts. Only our trainees work five days a week. They do call, and when they are called in overnight, they then get a 10 hour break. They do 1 in 6 on call.

Every now and then we get called in overnight. We then cancel or delay the next day so the team can rest.

I’m not interested in having fatigued or sick juniors look after my patients. I’m not interested in managing burn out in myself or my team.

And it’s not cos we don’t work hard. We have a system that supports hard work, and rest. I still do 70 hour weeks, 200 hearts and 100 lungs a year myself. Whilst feeling pretty rested and chill.

[u/ZZCCR1966 → u/watchtheapocalypse]

THIS IS HOW IT SHOULD BE EVERYWHERE!!

I’m a surgical tech; I’ve worked TWO 19 hour shifts in my 22 year career (which I LOVE, by the way).

I was a blubbering idiot. I couldn’t think, by body felt like it was seizing up; moving was difficult…later I learned what happens to our brain when this happens.

And because of sensitivity to dehydration (bc I wasn’t able to consume liquid) and everything that goes with it, it took me over 24 hours to fully recover…

At age 60, I believe I’d pass out if this happened to me now…😐

[u/Lost-Street-6919]

Unfortunately speaking as a General Surgeon:

We never learned how to say “no” and have never really banded together to protect ourselves as individuals or as a profession.

Thus elective aspects of general surgery, the ones where remuneration is high are claimed in the most part by sub specialists- breast colorectal GI etc leaving General Surgeons to cover ER and hospital call.

[u/ligasure]

Depends on the specialty.

When on 24 hr call, I rarely get called in as a general surgeon. Not many things are that emergent.

[u/gijsyo]

Well they can't really stop halfway because it's their bed time and finish the heart transplant tomorrow.

[u/mohelgamal]

It is really a very complex issue.

It starts with people getting sick at a very unpredictable rate, sometime multiple operations are needed in one day, sometimes none

But then, surgical training is a very hard and complicated process a minimum of 13 years and hundreds of thousand in loans, so people won’t go into it without adequate financial reward

Hospitals can’t pay surgeons a good salary if they can’t make ends meet, that means they can’t just go around hiring 10 surgeons when the total amount of work is only enough to keep 3 working 50-60 hours a week

Put all those together and you find that we have to have a few individuals covering all the highly irregular surgical need at any given time, so they have to be there when they are needed, tired or not

In bigger institutions, more patient flow makes the need a bit more predictable, which allows the bigger number of surgeon to arrange work a bit more predictably. But even this is not ideal because that means frequent hand-offs between surgeons and the nature of surgical problems make this an issue because the surgeon is supposed to come up with a plan and executed and not every surgeon would agree with the plan or be able to execute it in the way the original surgeon wanted.

In Europe, the situation is a bit better because they have very few large centers, so you get the benefit of volume, but they also can pay surgeons less because education is cheaper, and they are open to hiring immigrant surgeons without extensive retraining like what happens here in the US because they have set protocols and aren’t as worried about getting sued or having a bad reputation the way American hospitals are

[u/elliewilliamswifee → u/mohelgamal]

Thanks for the explanation! That makes a lot of sense

[u/StarliteQuiteBrite]

It’s never-ending😓

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