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Do you really work 90 hours? That's 13 hours a day 7 days a week. How does that even work logistically when you need to eat, sleep, commute, do laundry, shop for food, and hopefully also see family or friends on occasion.

I am nearing the end of medical school now, and I can assure you there are many surgeons who consistently work 80-90 hours/wk. I see it most often in surgeons who have subspecialized and do extremely technical work. Family, social, laundry, food, etc, all become things that you take care of whenever you get a free second. It's very, very difficult to describe the path a person takes to get to that point, but the profession can absolutely be all-consuming. It's one of the reasons surgery is less competitive as a specialty than it used to be - people see the brutal hours and make the choice to pursue options with a more attractive work-life balance.

Isn't that a little backwards though? The more surgeons there are, the more the work could be spread out, and the hours would be saner.

1.) It's a very time-consuming and hands-on process to train a surgeon. There aren't many other fields that I'm aware of with the same level of intense apprenticeship as surgery (and medicine in general). My first thought after entering medicine was to marvel at how much effort goes into training a single physician. There is a lot of training at between a 1:1 - 1:3 student-preceptor ratio in an effort to produce very high-quality physicians. So, the solution is not exactly as easy as, "well just make more surgeons."

2.) The federal government controls the number of residency slots each year, through Medicare funding for residency programs. I don't pretend to know the details of how it works, but my impression is that to get more residents per year, you need to convince Congress that it's necessary.

3.) Classic chicken-and-egg problem. Any medical student can go into surgery if they want to, unless their performance up till that point is seriously below par. However, there are many other specialties that offer more attractive lifestyles. So to increase the number of students who choose to do surgery, you'd need to find a way of signaling to students that the life of a surgeon isn't all back-to-back divorces, microwave dinners, and 80-90hr work weeks.

Q's re:

#2 - If Congress were convinced of that, would that help lower medical costs for patients or possibly increase it? That's assuming without some sort of tax increase to pay for it.

#3 - I guess this why I've heard that dermatology is one of the most competitive fields to get into - good hours, not as much stress, and good pay.

When I had my back surgery, my doc was there at 630a when I arrived for a 730a surgery, which took about 6 hours. He met me at 800p in PT to check on me.

I asked and he told me that was a fairly typical surgery day.

I'm assuming it's 90 billable hours. He said he waited two hours to do a ten minute procedure, sounds like most of his day is spent waiting rather than working.

That's two hours that he can't be off with his family, reading a book, having a drink, learning to juggle rings, so on and so forth. It's definitely 'work', even if it is standing there twiddling your thumbs because you're waiting on colleagues.

My wife is a neurosurgeon in residency and she absolutely works 90-~110 hours just about every week. She barely sleeps and eats one or two big meals a day (almost always ordered from Seamless), we have to live within a couple blocks of the hospital, and I just don't see how she would survive on her own if I wasn't around as far as food/laundry/etc.. is concerned -- I think that answers all of your questions.

I still remember the first day of my surgery rotation, when the head surgeon came in to give us a lecture: "Sorry if I'm a bit off, I just finished a 30 hour shift and haven't slept yet." lol. It varies greatly by specialty and program but I can assure there are physicians who literally test the limits of how much you can work in a week.

That sounds incredibly dangerous. I don't doubt that it happens, but I'd much prefer the person cutting me open to not be fatigued and exhausted.

It is. In surgical specialties, until very recently it not only happened but was absolutely normal and expected. I had one attending outright tell us that we (students) were not allowed to sleep on our 30 hour on-call shifts. To give some context, it is only recently that rules were passed to limit those hours -- to 80 (!!!) per week.

However, this is a vestige of the old culture and is slowly but surely being replaced both by new rules and, generally speaking, a better culture.

http://www.acgme.org/What-We-Do/Accreditation/Duty-Hours

And get time to read articles on HN

What do you think he does in the 110 minute he was waiting to do the 10 minute procedure?

My father is an oncologist. He's out the door before 5am and gets home at 7:30.

> I'm 47 years old, and work about 90 hours a week as a surgeon

Sorry, you and your industry should be ashamed of themselves for putting lives at risk. Mistakes from fatigue are a real thing. Maybe you are just cutting off bunions, but there still could be complications.

Interesting, I assumed that the field would become more selective over time. Or is it because just getting accepted to medical school itself is already extremely competitive?

The specialties with better quality of life (e.g. dermatology) have become increasingly competitive, drawing some of the top students away from the more masochistic fields.

I have heard that getting into medical school is a lot harder than it used to be too. It might be the reason why it's easier to be a surgeon once your in. I'm not a doctor or a med student, so take that with a grain of salt.

The thing is, medical school doesn't have to be insanely difficult. I've heard courses taught extremely well that made things like neuroscience a cake walk, and poorly taught courses like dermatology become very difficult due to the mindset I had while trying to study.

Why there's this dichotomy when there are clear examples of how to educate medical students 'right', I don't know. Maybe it's better for medical students like me to forget trying to go to class when there's poor quality teaching and try and learn it on my own. Or maybe in the grand scheme of things, it doesn't matter because the real education comes in residency.

My undergraduate degree was also in CS, did you ever feel like you wasted four years of your undergraduate education just to go into medicine later? I'm trying to position myself in such a way that I still get to use those sorts of skills after medical school, but I forget much of what I thought I knew, and the field changes constantly. L

I find it hard to believe you can work 90 hrs/week and not have your performance and judgement be impacted.

Maybe his performance and judgement are so impeccable that even after a 90-hour work-week he still operates better than the average.

I hope you are kidding! On the other hand I wouldn't put it beyond the surgeons I have met to think that way.

What do you think about current day surgery and potential technological change in the field (robot driven, nanotech [not smart molecules, but increasingly simple interaction at sub micron scale], large data monitoring and analysis for prevention) ?

Why do you have to work 90 hours a week? Why wouldn't your employer just offer a position with less hours for less money?

In software the long hours have specific reasons. For example we can't double throughput by doubling resources, and in startups the money is limited, etc

> In software the long hours have specific reasons.

Yes. Bad management and artificial marketing deadlines. You can't double the throughput in some cases by doubling the resources. (in some you can) But you don't have to work in the kind of environment that expects it. I got pulled into the environment that expected long hours once. Then the manager got replaced - throughput stayed the same, people started leaving on time and were much more happy.

I work with architects (building not software) that pull similarly long hours (and not great salaries) and when I point out that it sounds like a mix of poor planning, a poor deal with the client, or project management / process issues it's always shot down as being a 'part of their culture' that they've gone through since university.

My counterargument is that 'culture' isn't fixed and there's no reason not to strive for better and give people a chance to have lives outside work.

You're right those are also reasons. Unfortunately they're difficult to quantify. If there were an objective way to measure quality of management things would be vastly easier.

For example if a trusted management quality metric was reading "sucks", it would be easier to leverage change.

Can I ask if you're a surgeon in a private practice or hospital?