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Comment by Aunche | Hacker News Reader

A lot of surgeons have 80 hour workweeks. This is especially common is smaller hospitals in rural areas. It's not all surgery, but they're definitely not sitting at their desks and doing nothing. Before regulations, it was not uncommon for some doctors to work over 100 hours because they were in such high demand.

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although it should be noted that the performance problems with long work hours among physicians are known and drastic. As is the rate of drug abuse among physicians. So in a literal sense, you can do it, but physicians do it at the expense of their own health and their patients (not to their fault of course, the system is just screwed up).

This doesn't exactly address the point.

Human beings are only capable of sustained attention for limited periods of time, plus they have biological needs and must navigate a physical world.

Now, if you're just talking about time on the clock, then sure- 168 hours is the limit per week. But we're talking about people doing productive, mentally demanding work. 80 hours might not be possible.

Medical residents routinely do close to 80 hours, and I would argue on average a small single digit number of those hours are unproductive. My SO is an OB resident and worked over 90 hours last week, and probably 75 of that was either in surgery, reading, studying, or giving a presentation of one form or another. About half of her weeks are above the 80 hour limit.

It's definitely possible. Just because we don't want to do it (I don't either!) or that it has negative long-term consequences doesn't mean it's not possible.

Which hospital is that violating the legal limits on hours per week?

Every single one of them.

I'm aware of the legal limit and every single resident I've met has broken it at least once (really at least a couple times every quarter). The "good" programs will at least not require their residents to lie about it.

Hmm and it's no wonder that the 3rd leading cause of death is hospital error... hmm...

How much of that was hands-on and being on-call? Being on-premises or on-call within X minutes but allowed to do whatever including sleeping... Not exactly a match to creative work.

The extent of my knowledge is shadowing an an anesthesiologist back in my pre-med days, so take whatever I say with a grain of salt.

It is real hands-on-work. There simply aren't enough doctors who are willing to work in a small town, even though they would get paid a lot more. From what I understand, anesthesiology (and surgery) is mostly autopilot work, so there isn't that much creativity, but it still requires thinking. Usually people respond to drugs the way you expect them to, but you need to be able to handle situations where things go catastrophically wrong.

There's a few minutes of careful work and then more minutes packing up and commuting, and then repeat.

For how much of that time are they actually performing the specialized work or at least decision making that only they can do?

This sounds like moving the goalposts for the definition of work.

This schedule was established by a literal drug addict (cocaine and morphine) named William Halsted, not due to high demand.

And it’s since been reviewed and maintained due to the continual finding that continuity of care is so important to health outcomes that it makes up for exhaustion.

I think the continuity of care thing is overblown. There will always be a handoff because no one can work 24/7. One way specialties such as Emergency Medicine and Critical Care (which manage the Intensive Care Units) manage this is with overlapping shifts, where for the last hour of one shift and the first hour of the next shift overlap.

Emergency Medicine and Critical Care manage to do handoffs well, as well as nursing. I strongly disbelieve that surgeons are uniquely incapable of doing handoffs.

Handoffs need to be practiced to be done well. It's lazy to avoid them, but here we are.

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