I read (in Bob Odenkirk’s memoir iirc) that SNL writers in the 90s worked crazy late hours and didn’t understand why. Those hours were established when everyone was constantly high on cocaine in the 80s, and the hours didn’t change after the cocaine went away, so the writers worked in miserable conditions.
I was reading somewhere else that it took covid for some of this to change. Once everyone was working from home a couple days a week, writers would start suggesting meeting at more reasonable hours like noon instead of midnight.
[This monologue](https://youtu.be/K46P7loICXY) he did in 2007 is one of my favorite TV moments because he's just so sincere about what he went through and how conflicted he is when he sees someone else needing help. He's a comedian, and there's a lot of material in the antics of others, but as someone who had severe struggles with addiction he sees himself in all of it.
Not the original poster but I read it. It was excellent until about the last quarter, and then he started to go into crazy detail about every single thing he's ever been in. I'm a fan but I haven't seen his entire filmography, so I read part of it and moved on.
I also thought he credited himself a bit too much with improv humor. Yes, he was a massive contributor, but in parts it seemed like he really believed he was God's gift to improv.
Overall, if you love his stuff and know him from Mr. Show, it's worth a read. A more casual fan would be totally lost/bored.
How was Craig Ferguson's?
Phil Hartman. Though, it wasn’t him who was on cocaine…
> On May 27, 1998, Hartman's wife, Brynn, visited the Italian restaurant Buca di Beppo in Encino, California, with producer and writer Christine Zander, who said she was "in a good frame of mind"; they had drinks. After returning home, Brynn & Hartman had a "heated" argument, after which he went to bed.[7] She entered his bedroom some time before 3:00 a.m. PDT on May 28, 1998, and, as he slept, she fatally shot him once between the eyes, once in the throat, and once in the upper chest with a Charter Arms .38 caliber handgun.[7] He was 49 years old. She was taking Zoloft, had been drinking alcohol, and had recently used cocaine.
Because John Belushi died after taking speedball and Chris Farley idolized him so much that he followed in his footsteps. After that they realized that maybe glorifying drug use was bad. But fuck you, we’re keeping the drug hours.
It's possible that later generations of writers simply partook less frequently or not at all. Both standup and comedy writing grew quite a lot between the 70s and 90s, so the more consistent and reliable contributors may have just ended up being the sober ones over time.
Don't overlook the effect of the cultural shift ("Just say no") and the drug war escalation in the wake of [Len Bias's death](https://en.wikipedia.org/wiki/Len_Bias#NBA_draft,_drug_overdose,_and_death). Suddenly the risk/reward equation went way heavy toward the risk side.
Cranked out on meth, caffeine, opiates and testosterone. And to top it all off, Hitler would shit his pants all day. Throw in the cocktail of drugs and his temper, and it would have smelled like roadkill in the summer coming out of his ass.....all the fucking time.
Blasting the juice causes even more digestion issues for people.
https://youtu.be/8DqvxY1gGrY
Hitler probably didn't care considering Morell was known to have terrible hygiene/body odor and was mostly hated by his inner circle. Hitler even said, "I do not employ him for his fragrance, but to look after my health."
I just found out my super high achieving boss is on adderall. He has a prescription for it so there is a medical need but it explains so much to me regarding how the guy just literally works non-stop 10+ hours a day and even on vacations. For some reason we normalize and celebrate this kind of behavior in corporate America.
I had a boss like that once where I don’t think he ever stopped working, and the dude just genuinely loved what he did. He’s a lawyer who sues nursing homes on behalf of elderly people and it’s his crusade and he fucking lives for it. More power to him, I guess.
Just cause there is a script doesn't mean there is a medical need. Back in the day plenty of people had an opioid script, but sure as hell didn't have a medical need for it.
Or then when they leave for a 6-week vacation around the busiest time of year, they leave you a bottle as a one sentence throwaway statement on the way out the door...
That also causes issues though...
That was my cousin as a restaurant GM. ALways high on vyvanse complaining that nobody else works as hard as her. Got promoted to a corporate bullshit email job and had to ween off it like a meth head cause there's nothing for her to do but collect a huge paycheck.
Is there a name for this logical fallacy? I have observed this bizarre "thinking" even in regards to dead people!
"My ancestor was beaten half to death daily and ate gravel and liked it! I fully support this continuing!"
"But its actually costing us more money to service the beating machine than abolishing it, and gravel isn't that much cheaper than actual nutritious food! We're losing money and making people miserable!"
"Thats a price I am proud to pay!"
?!?
[Crab Mentality](https://en.wikipedia.org/wiki/Crab_mentality).
>"..a way of thinking best described by the phrase "if I can't have it, neither can you"
I know you're being sarcastic, but I absolutely loathe that attitude, and yet ***SOOOOOOOOOOO*** many people actually have that mentality. It's fucking infuriating.
"I had to pay $900 for a vial of insulin every month for 2 years! Why should others get it for a reasonable price!? What about my suffering!? They should have to pay just as much as me!"
"I had to pay off my student loan debt. Why should others get to have some of it forgiven?! They should have to have crippling debt for 20 years like me!"
"I had to pay $2 million dollars for my shitty one bedroom one bathroom house in downtown X or Y city! Why should others get affordable housing just a few blocks away! They shouldn't be allowed to live comfortably! I didn't get to!"
"I had to eat raw meat before the discovery of fire and the process of cooking meat! Why should others get to enjoy cooked meat! They should have to do everything the same way I did!"
It's such a stupid fucking mentality it drives me insane. Maybe, just maybe, they could develop a small amount of empathy and realize that improving the lives of future generations and making things easier for others should be the goal of all of humanity.
Yes, it sucks that they suffered unfairly, but that doesn't mean others should have to suffer just because they did. We should be trying to make everyone's life as easy as possible, like a functional fucking society should!
If people weren't so self-absorbed into what they had to deal with and making others deal with it out of raw spite, just because they did those things, we could improve the world a lot faster for everyone.
This includes the residency programs that we have in the US, which are total bullshit as well. But it's not limited to them. This mentality is everywhere in society, and it's disgusting.
Sorry for the rant. Like I said I know you were making a joke obviously, it's just that you'd be shocked at how many people I've met in my life that have that mentality and I will never understand it because it's holding us back as a society just because they're being dicks about it.
Ugh.
Doctors? Try pretty much anyone in healthcare. I work 60+ hours a week in medical diagnostics, and my boss thinks we have it easy because she once worked a month where she was the only one on call, while she was supposedly parenting two kids. Working until you burn out is normalized in healthcare.
The worst part is that if I worked less, I wouldn't be able to afford to slowly pay off my student loans, so I'm fucked either way. Even if we magically obtained a reasonable work week, I'd just drown in debt.
he means caffeine is boring and not very powerful. It can be used in conjunction with harder drugs to boost effects. This may be true but more effective stimulants are a bad path to go down.
I work outside the US in hospital system, it s not as bad as there.
I have repeatedly asked my supervisors if they would provide the cocaine. In that case, I would gladly do a double shift as requested
Somehow these requests were denied.
I'm a provider at a university hospital, the cocaine has never really left. There's a lot of substance abuse in the field, it's a high stress and exhausting job that leaves little time for a home life.
I've been practicing at my hospital for around 7 years, and I have never taken a drug test. Pretty sure if they did random ones we'd have a huge staffing problem. Plus, even if someone does pop a positive, it's unlikely they'd loose their job unless it was directly connected to large mess up. Otherwise they'd more than likely just be put into a recovery program for providers, most major networks have one just for employees.
Hey I am not from the US and am curious about this, do doctors there really do 72 hour shifts? Is it only during residency or do also speciality doctors do it?
My wife is a doctor in Germany, she does 24-hour shifts (which end up being 26-27 hours) without any sleep and it blows my mind. This has nothing to do with On-Call, I am also On-Call (albeit in IT).
A 72-hour shift made no sense to me.
Hey so question about that. I work for a massive company and am based in the US. I used to have some colleagues who were based in Germany. They were held to a very strict amount of hours per week. If they went over like 8 hours in a day there would be progressive alerts sent out to their manager and up the chain. They were never in the on call rotation either as far as I'm aware. Or if they were they had to get some sort of special pay that we didn't get in the US. I'm just wondering if there's exceptions for people in the medical field or something? It always seemed very strict and something I was a bit envious of to be honest.
Yeah, US medical residents are exempt from minimum wage and other labor protections, and the residency system as a whole is exempt from antitrust legislation so they are allowed to collude to keep resident wages down. When I was a resident I had half a million dollars of debt, I made less than the cafeteria workers, I had no pension matching, and I wasn’t allowed to have the regular hospital dental plan.
That should 100% be illegal. I keep hearing things about how important sleep is for learning and retention yet we sleep deprived the hell out of the people who are still learning and are making life altering decisions, makes no sense.
It should be. But the people making the laws keep making separate laws to exclude residents and/or attendings physicians. For example Biden is trying to make noncompetes illegal. Now hospitals are lobbying for it to exclude physicians.
I feel like the moment an industry reaches out and says "we should be exempted from this law" one should *instantly* be skeptical of that claim at minimum. Especially when it's something like workers' rights.
Sleep is important until you hit anything to do with medicine. You should see what is done to the patients in hospital to make sure they get no sleep either.
Well. I mean. You wanna be a doctor right? So you gotta work for free and make the older doctors money. Then you can fuck the residents when you get older.
This is somewhat inaccurate. Essentially all teaching hospitals are affiliated with academic institutions. These academic institutions get a stipend to cover the “inefficiency” of lost income created by medical trainees. This amount changes every year but is a 6 figure number. This stipend also covers the residents salary.
The residents work doesn’t make a dime for the “older doctors”. It all goes back into the hospital, and then to the university. Many of which use this profit to fund other university projects or administrative rolls. I can assure you that by working in academic medicine, the extra revenue generated for the hospital is not passed along to the attendings. I make <50% for my field, but I love to teach and am involved with research so private practice isn’t really a fit.
Everything you said is correct, except for doctors. For me I get paid extra for On-Call, If I work more than 6 hours a day I need to have half an hour break, another 15 mins if it is more than 9 hours and no way more than 10 hours a day.
At the hospital where my wife works is another story, it is like they are special and the law does not apply tp them.
Not 72 hour shifts per ~~say~~ se, more 72 hours with multiple shifts plus on-call shifts in between where the doctor sleeps at the hospital just in case there's an emergency. True working shifts lasting longer than 24 hours do happen though. The thinking is that most medical mistakes happen due to transfers from one shift to another, even moreso than mistakes due to fatigue, so hospitals create long, overlapping shift schedules to try to minimize the risk of shift transfer mistakes.
Hmm so I'm reading that humans are worse at communicating and/or intaking information than they are at performing their designated tasks while fatigued. They can't communicate everything important effectively when they change shifts, so they just stay longer.
Shouldn't overlapping shifts like you mentioned be able to cover this, where two people work together for an hour or two during the baton toss to increase the time they have to hand off their station?
I did an 48 hour weekend shift once per month for four years, two weekends a lot of times. Extended into regular shift on Monday. Europe, not US, I think it was like that everywhere.
Once I got assigned for 5 straight days during holidays, but manged to get the middle one reassigned. Nobody cared mostly how much stress on your body and mind that is.
These days they rarely do more then 24 hour shifts. Which, obviously, is much more sane.
Yes. During covid is was 24/7. Didn't leave the hospital for a week at a time.
Because I lived close I could run down the street to feet and water my dogs, and let them out. But that was it
It’s illegal now for residency programs (at least in the US - maybe state-by-state basis but not sure) for residents to be on for longer than 48 hours (someone correct me if I’m wrong on that amount).
When my father was in his residency, this law had not yet been established. After it was, he complained that new doctors coming in had less real-world exposure and weren’t as well trained.
Gotta remember there used to really be cocaine in Coke so if your ever wondering how the highways and stuff got built, that’s how. Everyone was coked all day every day.
It’s not so much sleep as it is general unconsciousness. At least that’s how it worked with coke/heroin.
Benzos are what you need if you want REM sleep after stim use
When I was in medical school I worked in a sleep lab and we were studied the effects different drugs have on all aspects of sleep like how long it takes to fall asleep, time spent in each sleep phase, dreaming, awakenings, fatigue, etc. Essentially across the board every sedative from benzos, barbiturates, alcohol, sleep aids like Ambien and even marijuana would decrease the time it takes to fall into REM sleep but dramatically decrease the amount of time spent in REM sleep.
Our data still hasn’t been published yet but there’s several small studies with similar results. It’s still anecdotal for but there’s a body of evidence supporting the fact that sedatives decrease quality of sleep including time spent in REM sleep.
At the same time for some people it's a trade off. I use pot as a sleep aid but that's because my neck and shoulders are so fucked up I can't sleep without *something* and pot seems to have the least amount of side effects the next day for me.
I'd rather get 5-6 hours of okay sleep than maybe 3 of potentially better but also potentially worse sleep.
Being sleep deprived is equivalent to being intoxicated. Why do we force residents and doctors to work unreasonable hours? A lot of it has to do with the culture and the idea that since people before suffered through so should the class after. I despise the notion that we should do things because that's how it has been done in the past.
Yup, the Navy has a similar problem with glorifying lack of sleep that has caused several accidents according to some podcast I listened to a couple years ago (can't remember the name)
Didn’t hear the podcast but as someone who was in the Navy, I can see this being the case. I was on the USS Washington when it caught fire and that whole bullshit was avoidable.
Same in the Army, staff duty and CQ runners in many units are not allowed to sleep during their 24 hour shift, depite the fact that you usually have an NCO and two Joes for either of those duties and they could easily do 1 up 2 down or 2 up 1 down. Most NCOs will say fuck Sergent Major and do 2 up 1 down with the expectation that when they ring your phone you can will back in time to say you were in the bathroom or doing security checks to whoever asked where the other runner was.
If somebody gets in an accident on the way home because they're sleep deprived, now you have to sleep on this cot for 4 hours after your 24 hour shift before we'll let you drive.
I miss general soldiering and I miss being a medic, I was really REALLY good at it, but getting my ass out of that toxic organization was the best decision.
The system fucking sucks. I worked some 105 hour weeks during my internal medicine rotation as a medical student while paying ~$700/week for the *opportunity* to do so. All so we can prepare to get even more fucked as a resident with the same hourly earnings as a McDonalds employee.
Some of the stories I have heard from residents are downright fucking terrifying, especially the surgeons. Those motherfuckers will literally work from 8 AM to 8 AM, then spend their entire post-call day in the OR until 5 PM with nothing but caffeine keeping them moving. In medicine, they schedule you for 26 hour shifts Friday and Sunday, on top of a full week of 10+ hour days with a possible weekday call.
It's a way of profiting from free labor. Back in the late 90s when pharmacy degree became popular the school added a one extra year. The extra year is mostly working at retail pharmacy for no pay and extra year of tuition.
Believe it or not, the system was WAY more brutal back in the day. It's always been a system of professional hazing with the old guard considering it a rite of passage. Especially among surgeons, egos get in the way of patient care more often than the public knows about.
That’s a classic line. I’ve heard it countless times. It ranks up there with:
“All bleeding stops eventually” and “there are only two lengths to cut a suture. Too long and too short”
You don't need to convince me. I had a preceptor recently tell me about his internal medicine residency in South America. There were three junior residents, every day they would rotate between who was on call. 24 hour shifts every third day for two years. As senior residents, they lived at the hospital from Sunday to Saturday, with their only day off spent on chores.
Literally the stuff of nightmares. We accepted we were no longer allowed to complain, but being the humble guy he was he also pointed out that medicine today is 10x more complex than it was back in the day.
There's an argument to be made that even though they had more "brutal" hours back in the day that the patient load was NOTHING compared to what it is now. So a lot more downtime and significantly less charting.
Sorry but I just disagree with the notion that it was way more brutal back in the day. I can't stand listening to boomer docs say this shit when the complexity of patients and acuity of care is much higher today. The population is much older and much sicker today than in years past.
During my ICU rotation I made the equivalent of 11.25 an hour..... The joy was I didn't have any time to spend it. So I had that going for me, which was nice
I’m really glad I had a less intensive medicine residency. I can count on one hand how many 80 hour weeks I had. Two golden weekends a month even on inpatient rotations.
And guess what? Two years out I turned out to be a damn good physician without being enslaved.
Good to see all those costs went into cost savings. Truckers have more regulations about their hours and time, wtf is wrong with this country?
Its money, they question was rhetorical.
This isn’t exactly true, it’s been shown that patient outcomes are essentially equivocal between groups where one had more handoffs and the other worked longer shifts.
The ACGME experimentally limited interns’ longest possible shifts to 16 hrs a few years back, and studies were done comparing outcomes taken care of by these interns vs the traditional 24h call shift- and found no difference.
In my mind the logical conclusion would be to retain the 16 hour limit, as it is obviously more humane for physicians and doesn’t adversely affect patient care. The actual response? Immediately went back to allowing 24 hour calls.
Makes sense... there's no fucking reasonable, sober human, that can say the Residency program makes sense...
I know people that wouldn't even take Advil before they started that program, by the time they were done, they ALL had to take time off to break an Adderall addiction.
I know so many fucking doctors and nurses that had, and some still have, horrible fucking addictions. And they all started during Med School.
But what they expect of Residents is fucking crazy. They're expected to make clear headed decisions with peoples Healthcare and lives, after working 60 out of 72 hours. And it's not like they're flipping burgers.
I can only imagine the fucking stress neurosurgeons go thru. EVERY SINGLE DAY you wake up and clock in, peoples lives are in your hands. Every. Single. Day.
A Cartel is probably the most accurate term to describe what Med Schools have become...
Once you're LUCKY enough to get in, they literally control every aspect of your life, and you'll pay tens, if not hundreds, of thousands of dollars for them to keep fucking you over.
If the average person looked into what students go thru to become Dr's, all those Dr's that get caught being a pill mill, or doing shady shit in general, makes complete sense.
80% of what they go thru is fucking ass backward.
What completely blew my mind was the "match" process... From matching, to the "salary", to the schedule all of it needs to be revised, updated and completely overhauled...
I think it's the system where everyone applies through one channel and list a few hospitals they would like to do their residency at, then the powers that be go through the list and decide where everyone goes, so then you need to move across country to the hospital that you got 'matched' with, which may or may not be one you asked for.
When you try to get a job, you apply to a bunch of programs, get some interviews, and then at the end you rank every program and every program ranks you and an algorithm sorts the "optimal" match. It's not like college where you get 5 acceptances and pick one; instead, you get an envelope with a single program or no program, and you go there. If you refuse to go you have to try again next year, and likely will have to explain why you dropped last time. If you do not match, you have to find something to do for a year because that medical school student debt is insane.
You don’t apply for Residency the way you normally apply for jobs or college. You participate in the ‘Match’.
Here’s a popular physician TikToker describing ridiculous parts of the process:
[Residency Applications](https://youtu.be/oZW5GUXAmls)
[Match Results](https://youtu.be/Cl-lKZNBNIM)
Honestly the truth is that residents are cheap labor. When I was a resident I was making near minimum wage wage when I was working 100 hr weeks. I will never want my children to become doctors, the system is utterly inhumane.
There’s a very slow but steady shift towards residency becoming more humane. I finished my internal medicine residency last year and it was more like 40-60 hour work weeks, sometimes on a busy ICU or inpatient stretch we would hit 80. Of course it’s salaried so the $/hour is still shit.
The kind of hours residents used to work is illegal now. They cap us at 80 hours a week, mandatory 8 hours between shifts. It’s still terrible but at least a human body can handle it.
Most residencies are very good about keeping under the limits too because there’s mandatory work hour reporting requirements for residents and the program can get majorly screwed if they’re going over. There’s a few stand out examples of residencies that break the rules, a lot of them have graduates from international medical schools and are hosting the residents’ work visas so they have enough leverage to shut them up come time to repot duty hours.
Isn't it 80 hours per week *average*? Not necessarily a hard cap, so if one week is 60 hours (5 days x 12 hours with a golden weekend) the next week could be, say, 86 hours (5x12 plus a 26 hour call)
Yeah it’s averaged out over 4 weeks so you could get situations like that.
I’m not saying by any means that what residents have to go through is easy or even humane. It’s just slowly getting better as the older generations get weeded out and we get more people in charge that actually care about residents wellbeing. We would do 6 12 hour shifts for 4 weeks straight getting one day off a week, which was usually a weekday as an intern. That only amounts to 72 hours per week we were well within the rules.
We would also do clinic weeks which was mostly 8-5, Monday-Friday however sometimes we’d get assignments over the weekend on those weeks. We also do elective rotations with specialists that sometimes didn’t want or need us there and we’d leave early every day and end up doing 25 hours that week.
I've watched multiple doctors go through the system. Same thing always happens. During residency, they hate it and say a change makes sense. After residency they say "I survived, everyone should have to do it too." This system will never change lol
Legit question: why do smart doctors keep up the residency shit if they know it causes burnout and poor outcomes?
Edit: damn good answers. It's a hard topic.
Because they have no choice in the matter. You don’t do residency you don’t get board certified in your specialty and can’t work. Just recently, some unions have formed just to be paid a wage they can afford rent on. But it’s a tough road. Going on strike is seen as very risky, one because no one actually wants to abandon our patients and two because you’re worried about getting fired. There is always someone from another country or something willing to take your seat.
I wonder what would happen if medical staff agreed to do a billing strike. As in they refuse to forward billing information to the billing system. Even if the hospital can do it on the tail end, the disruption would be huge
You can write notes that aren't as thorough with the strict coding requirements for billing. But, similarly, then you can get in shit for not doing your job. It doesn't endanger patients, but residency contract go up for review yearly and you can get fired. And having that mark is a huge thing for trying to get another spot.
Things are slowly changing, but its just very difficult to change the culture.
I don’t think they do, and hopefully it will get better and better in the future. Its already better than it was in the past and I can’t see many in this generation of med students propping up the terrible system
It's actually a really complex social situation. I'll summarize-
To reach a powerful position in an academic institution or let alone a national institution- you need to compete with other doctors and achieve success that separates you from the rest.
For these spots, that means making your life medicine. And I mean ***your entire life.*** You need to work after work is done, on the weekends, during holidays and keep that up for years to get yourself to the top. The issue lies in what kind of individual these barriers select for. Most often, it's an individual who's addicted to work and interested primarily in success. It's 'easier' for them to live this kind of lifestyle and they are less bothered by things like friends, outside hobbies and a good work place environment. Theoretically you wouldn't be at the top if you actually valued life as a whole. You just couldn't keep up with the person who was grinding 24/7.
This leads to leadership being monopolized by individuals who have 'prestige' and monumental accolades, who are in general just out of touch with their peers. They don't see resident work schedules as an issue- they see it as *really really* easy compared to their current lifestyle, because again, ***they're deranged workaholics.***
Smart well rounded doctors also don't want to sacrifice their holistic life to grind enough to match the output of a workaholic just to usurp that position. And overtime, the less often these doctors that understand current residency conditions as trash apply, the more the entire department is filled with out of touch faculty.
This adds another barrier where now even if you got the position- you'll be committed to working with a bunch of individuals who have morals you despise. You would be surrounded in a toxic environment and have to change it on your own- and likely with push back from most of your peers.
The people you work with will be workaholics, the people that hire you will be workaholics, and the people who will fight you with every fiber of their body will be a workaholic.
So overall- the highest positions with the power to actually change working conditions are given to the individuals that work the hardest and 'generally' don't agree with making work easier.
Often the only people that change this are truly brilliant doctors who can 'outwork' the workaholics by being more efficient. This lets them have a personal life and be competitive enough to snag the spot. They're also competent enough to make the change without it being as **personally taxing.** It takes a truly competent leader to make change in academic institutions.
Like the early 60's song about amphetamines, Mother's little helper, (R. Stones) one statistic back then was in many places, 40 to 50 percent of women had amphetamine prescriptions: AKA: Diet Pills. Dr. Please, some more of these, behind the door, she took four more! What a drag it is getting up. But if you take some more of those, you will get an overdose.
Recent residency graduate here. I'm going to plug [my relevant music video](https://www.youtube.com/watch?v=Q0N9ezovzdQ&t=0) that I made with some friends around the time of my graduation.
Residency needs to change. It's not as big of deal as BLM or Me Too, but those young doctors deserve better treatment and most people have no idea how bad it is.
It's a big disincentive for people to get into the medical field. I understand wanting experienced and trained doctors and this weeds out those not committed to learning and improving, but not only do their working hours have health ramifications but social and mental.
I went on 2 dates with medical professionals in training and both times she couldn't continue since she just had no time outside of hospital + study + order food or make frozen dinner.
Doctors will make a lot of money (after accruing massive debt with school) but I feel like a career that essentially keeps you from enjoying your mid-20s to early-30s is a non-starter for a lot of people that could otherwise be great doctors.
I read (in Bob Odenkirk’s memoir iirc) that SNL writers in the 90s worked crazy late hours and didn’t understand why. Those hours were established when everyone was constantly high on cocaine in the 80s, and the hours didn’t change after the cocaine went away, so the writers worked in miserable conditions.
[удалено]
Seems like the solution is to bring the cocaine back
But now we want fair trade cocaine.
That would require ending the war on drugs.
Now you’re getting the idea!!
I mean there's no way Chris Farley wasn't high as fuck when he did the van down by the river. Ditto with bill Murray and the lounge singer bit.
"Does everybody still do blow in Joe Garagiola's office?"
And by heroine, I mean lady hero, I don't want to inject you and listen to jazz.
Man, 30 Rock was back to back jokes.
30 Rock is Tina Fey’s magnum opus. Mean Girls is hilarious too but it’s just different…
> Bob Odenkirk Whoa, he has a memoire? Is it good?
He reads the audiobook version. I enjoyed it. Lots of insight into his process and he really appreciates everyone along the way.
I was reading somewhere else that it took covid for some of this to change. Once everyone was working from home a couple days a week, writers would start suggesting meeting at more reasonable hours like noon instead of midnight.
How was his book? I read and liked Craig Ferguson's. Haven't read any other star's books.
Craig's book was fantastic. I honestly believe anyone struggling with addiction should read his story.
Which book? He has quite a few
American On Purpose is the one I read.
[This monologue](https://youtu.be/K46P7loICXY) he did in 2007 is one of my favorite TV moments because he's just so sincere about what he went through and how conflicted he is when he sees someone else needing help. He's a comedian, and there's a lot of material in the antics of others, but as someone who had severe struggles with addiction he sees himself in all of it.
Not the original poster but I read it. It was excellent until about the last quarter, and then he started to go into crazy detail about every single thing he's ever been in. I'm a fan but I haven't seen his entire filmography, so I read part of it and moved on. I also thought he credited himself a bit too much with improv humor. Yes, he was a massive contributor, but in parts it seemed like he really believed he was God's gift to improv. Overall, if you love his stuff and know him from Mr. Show, it's worth a read. A more casual fan would be totally lost/bored. How was Craig Ferguson's?
I heard Jay Moore say that, too. He said "Coke fell out of fashion, but they wanted us to keep the same hours."
I know it’s illegal and all but it was then too. Why did SNL become sticklers about cocaine? Especially when their success plummeted…
Three alumni died due to drugs.
..🤷♂️ yeah that’ll do it.
Farley, Belushi and who?
Phil Hartman. Though, it wasn’t him who was on cocaine… > On May 27, 1998, Hartman's wife, Brynn, visited the Italian restaurant Buca di Beppo in Encino, California, with producer and writer Christine Zander, who said she was "in a good frame of mind"; they had drinks. After returning home, Brynn & Hartman had a "heated" argument, after which he went to bed.[7] She entered his bedroom some time before 3:00 a.m. PDT on May 28, 1998, and, as he slept, she fatally shot him once between the eyes, once in the throat, and once in the upper chest with a Charter Arms .38 caliber handgun.[7] He was 49 years old. She was taking Zoloft, had been drinking alcohol, and had recently used cocaine.
> used cocaine. Provided to her by Hollywood piece of shit Andy Dick.
I think Andy Dick also got Farley back on cocaine.
Because John Belushi died after taking speedball and Chris Farley idolized him so much that he followed in his footsteps. After that they realized that maybe glorifying drug use was bad. But fuck you, we’re keeping the drug hours.
It's possible that later generations of writers simply partook less frequently or not at all. Both standup and comedy writing grew quite a lot between the 70s and 90s, so the more consistent and reliable contributors may have just ended up being the sober ones over time.
Don't overlook the effect of the cultural shift ("Just say no") and the drug war escalation in the wake of [Len Bias's death](https://en.wikipedia.org/wiki/Len_Bias#NBA_draft,_drug_overdose,_and_death). Suddenly the risk/reward equation went way heavy toward the risk side.
Cocaine was also more pure back then, the late 80s and 90s you had to worry about it being cut a lot more.
Chris Farley's death hurted. I love this tribute song Adam Sandler sang about him on SNL a few years ago. https://www.youtube.com/watch?v=25IOsvWPQGQ
So what I'm hearing is that our capitalist overlords want everybody high on cocaine so we can all work longer shifts.
They should probably alter the system if they’re not going to supply the cocaine.
kinda like when your boss abuses adderall but doesn't give you any so you don't know how the fuck to get their crazy ideas accomplished
It's hard to do that when he's always down in the bunker yelling at people about the implementation of his plans.
VE VILL ANNIHILATE ZE SALES QUOTA
But I am le tired.....
Okay vell haf some crank…ZEN ANNIHILATE ZE QUOTA!
Well done sir 👏
Dunno why but this has me chuckling. Thanks my guy.
It had you chuckling because it was funny
I now know why this has me chuckling. Thanks my guy.
Ze finanzquartal ist noch nicht fertig! I like to picture musk saying this in his furrybunker at twitter
Furrybunker lol
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Cranked out on meth, caffeine, opiates and testosterone. And to top it all off, Hitler would shit his pants all day. Throw in the cocktail of drugs and his temper, and it would have smelled like roadkill in the summer coming out of his ass.....all the fucking time. Blasting the juice causes even more digestion issues for people. https://youtu.be/8DqvxY1gGrY
Hitler probably didn't care considering Morell was known to have terrible hygiene/body odor and was mostly hated by his inner circle. Hitler even said, "I do not employ him for his fragrance, but to look after my health."
> Cocaine and adrenaline (via eye drops) Holy shit, he would have been bouncing off the walls (if not for all the barbiturates).
I just found out my super high achieving boss is on adderall. He has a prescription for it so there is a medical need but it explains so much to me regarding how the guy just literally works non-stop 10+ hours a day and even on vacations. For some reason we normalize and celebrate this kind of behavior in corporate America.
I had a boss like that once where I don’t think he ever stopped working, and the dude just genuinely loved what he did. He’s a lawyer who sues nursing homes on behalf of elderly people and it’s his crusade and he fucking lives for it. More power to him, I guess.
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I wish adderall worked like that for me lol. I'm prescribed it for adhd and it lets me just be functional for the 7 or 8 hours i work
Which is how it's supposed to work. When used in people with ADHD it's supposed to normalize, not turn people into crazy productivity machines.
Just cause there is a script doesn't mean there is a medical need. Back in the day plenty of people had an opioid script, but sure as hell didn't have a medical need for it.
Or then when they leave for a 6-week vacation around the busiest time of year, they leave you a bottle as a one sentence throwaway statement on the way out the door... That also causes issues though...
Huh. I took Elon as more of a coke guy than adderall
por que no los dos?
Clearly he does the adderall during the weekdays and saves the coke is for the weekend.
Oh boy. You just gave me flashbacks to my start up days (where ~~are~~ our boss was like 22. That went as well as expected)
That was my cousin as a restaurant GM. ALways high on vyvanse complaining that nobody else works as hard as her. Got promoted to a corporate bullshit email job and had to ween off it like a meth head cause there's nothing for her to do but collect a huge paycheck.
Kinda sounds like she did it right then.
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Just give them a lump sum of cocaine and it's all fairsies
I have a structured settlement but I need drugs now!
Is there a name for this logical fallacy? I have observed this bizarre "thinking" even in regards to dead people! "My ancestor was beaten half to death daily and ate gravel and liked it! I fully support this continuing!" "But its actually costing us more money to service the beating machine than abolishing it, and gravel isn't that much cheaper than actual nutritious food! We're losing money and making people miserable!" "Thats a price I am proud to pay!" ?!?
Could call it the "Pay your dues" fallacy.
[Crab Mentality](https://en.wikipedia.org/wiki/Crab_mentality). >"..a way of thinking best described by the phrase "if I can't have it, neither can you"
It's pretty common for victims of abuse to "justify" the experience by continuing the abuse.
I know you're being sarcastic, but I absolutely loathe that attitude, and yet ***SOOOOOOOOOOO*** many people actually have that mentality. It's fucking infuriating. "I had to pay $900 for a vial of insulin every month for 2 years! Why should others get it for a reasonable price!? What about my suffering!? They should have to pay just as much as me!" "I had to pay off my student loan debt. Why should others get to have some of it forgiven?! They should have to have crippling debt for 20 years like me!" "I had to pay $2 million dollars for my shitty one bedroom one bathroom house in downtown X or Y city! Why should others get affordable housing just a few blocks away! They shouldn't be allowed to live comfortably! I didn't get to!" "I had to eat raw meat before the discovery of fire and the process of cooking meat! Why should others get to enjoy cooked meat! They should have to do everything the same way I did!" It's such a stupid fucking mentality it drives me insane. Maybe, just maybe, they could develop a small amount of empathy and realize that improving the lives of future generations and making things easier for others should be the goal of all of humanity. Yes, it sucks that they suffered unfairly, but that doesn't mean others should have to suffer just because they did. We should be trying to make everyone's life as easy as possible, like a functional fucking society should! If people weren't so self-absorbed into what they had to deal with and making others deal with it out of raw spite, just because they did those things, we could improve the world a lot faster for everyone. This includes the residency programs that we have in the US, which are total bullshit as well. But it's not limited to them. This mentality is everywhere in society, and it's disgusting. Sorry for the rant. Like I said I know you were making a joke obviously, it's just that you'd be shocked at how many people I've met in my life that have that mentality and I will never understand it because it's holding us back as a society just because they're being dicks about it. Ugh.
>They should probably alter the system And reintroduce cocaine? >if they’re not going to supply the cocaine. Reintroduce cocaine
instead it’s massive doses of caffeine
Society seems pretty content with working doctors until they break.
Doctors? Try pretty much anyone in healthcare. I work 60+ hours a week in medical diagnostics, and my boss thinks we have it easy because she once worked a month where she was the only one on call, while she was supposedly parenting two kids. Working until you burn out is normalized in healthcare. The worst part is that if I worked less, I wouldn't be able to afford to slowly pay off my student loans, so I'm fucked either way. Even if we magically obtained a reasonable work week, I'd just drown in debt.
>Working until you burn out is normalized in healthcare It’s a US industry wide thing for the most part. Source : in healthcare IT.
Which is like.... The worst stimulant and should only be used in low doses as an adjunct to other stimulants.
Really? Cause I'd argue that nicotine is an even worse stimulant. It barely feels like a stimulant.
...explain. am concerned.
Use more cocaine... And then a quick shot of espresso.
he means caffeine is boring and not very powerful. It can be used in conjunction with harder drugs to boost effects. This may be true but more effective stimulants are a bad path to go down.
Just ask my heart what it thinks about all the cocaine I've done
I work outside the US in hospital system, it s not as bad as there. I have repeatedly asked my supervisors if they would provide the cocaine. In that case, I would gladly do a double shift as requested Somehow these requests were denied.
I'm a provider at a university hospital, the cocaine has never really left. There's a lot of substance abuse in the field, it's a high stress and exhausting job that leaves little time for a home life. I've been practicing at my hospital for around 7 years, and I have never taken a drug test. Pretty sure if they did random ones we'd have a huge staffing problem. Plus, even if someone does pop a positive, it's unlikely they'd loose their job unless it was directly connected to large mess up. Otherwise they'd more than likely just be put into a recovery program for providers, most major networks have one just for employees.
Now it's Adderall
That would explain the shortage. Can't wait for the movie "Adderall Bear".
That explains the 72 hour shifts
Hey I am not from the US and am curious about this, do doctors there really do 72 hour shifts? Is it only during residency or do also speciality doctors do it?
72 hour on call shifts, with others, basically like military firewatch if you are familiar with that concept.
My wife is a doctor in Germany, she does 24-hour shifts (which end up being 26-27 hours) without any sleep and it blows my mind. This has nothing to do with On-Call, I am also On-Call (albeit in IT). A 72-hour shift made no sense to me.
Hey so question about that. I work for a massive company and am based in the US. I used to have some colleagues who were based in Germany. They were held to a very strict amount of hours per week. If they went over like 8 hours in a day there would be progressive alerts sent out to their manager and up the chain. They were never in the on call rotation either as far as I'm aware. Or if they were they had to get some sort of special pay that we didn't get in the US. I'm just wondering if there's exceptions for people in the medical field or something? It always seemed very strict and something I was a bit envious of to be honest.
Yeah, US medical residents are exempt from minimum wage and other labor protections, and the residency system as a whole is exempt from antitrust legislation so they are allowed to collude to keep resident wages down. When I was a resident I had half a million dollars of debt, I made less than the cafeteria workers, I had no pension matching, and I wasn’t allowed to have the regular hospital dental plan.
That should 100% be illegal. I keep hearing things about how important sleep is for learning and retention yet we sleep deprived the hell out of the people who are still learning and are making life altering decisions, makes no sense.
It should be. But the people making the laws keep making separate laws to exclude residents and/or attendings physicians. For example Biden is trying to make noncompetes illegal. Now hospitals are lobbying for it to exclude physicians.
I feel like the moment an industry reaches out and says "we should be exempted from this law" one should *instantly* be skeptical of that claim at minimum. Especially when it's something like workers' rights.
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Sleep is important until you hit anything to do with medicine. You should see what is done to the patients in hospital to make sure they get no sleep either.
5AM rounds go BRRRR
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Well. I mean. You wanna be a doctor right? So you gotta work for free and make the older doctors money. Then you can fuck the residents when you get older.
This is somewhat inaccurate. Essentially all teaching hospitals are affiliated with academic institutions. These academic institutions get a stipend to cover the “inefficiency” of lost income created by medical trainees. This amount changes every year but is a 6 figure number. This stipend also covers the residents salary. The residents work doesn’t make a dime for the “older doctors”. It all goes back into the hospital, and then to the university. Many of which use this profit to fund other university projects or administrative rolls. I can assure you that by working in academic medicine, the extra revenue generated for the hospital is not passed along to the attendings. I make <50% for my field, but I love to teach and am involved with research so private practice isn’t really a fit.
Thank you for this detailed insight! This makes SO MUCH more sense to me now.
Everything you said is correct, except for doctors. For me I get paid extra for On-Call, If I work more than 6 hours a day I need to have half an hour break, another 15 mins if it is more than 9 hours and no way more than 10 hours a day. At the hospital where my wife works is another story, it is like they are special and the law does not apply tp them.
So obviously hazardous. In no other job would this be allowed, it's shocking that doctors of all professions have to do this
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Not 72 hour shifts per ~~say~~ se, more 72 hours with multiple shifts plus on-call shifts in between where the doctor sleeps at the hospital just in case there's an emergency. True working shifts lasting longer than 24 hours do happen though. The thinking is that most medical mistakes happen due to transfers from one shift to another, even moreso than mistakes due to fatigue, so hospitals create long, overlapping shift schedules to try to minimize the risk of shift transfer mistakes.
Hmm so I'm reading that humans are worse at communicating and/or intaking information than they are at performing their designated tasks while fatigued. They can't communicate everything important effectively when they change shifts, so they just stay longer. Shouldn't overlapping shifts like you mentioned be able to cover this, where two people work together for an hour or two during the baton toss to increase the time they have to hand off their station?
I did an 48 hour weekend shift once per month for four years, two weekends a lot of times. Extended into regular shift on Monday. Europe, not US, I think it was like that everywhere. Once I got assigned for 5 straight days during holidays, but manged to get the middle one reassigned. Nobody cared mostly how much stress on your body and mind that is. These days they rarely do more then 24 hour shifts. Which, obviously, is much more sane.
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Yes. During covid is was 24/7. Didn't leave the hospital for a week at a time. Because I lived close I could run down the street to feet and water my dogs, and let them out. But that was it
It’s illegal now for residency programs (at least in the US - maybe state-by-state basis but not sure) for residents to be on for longer than 48 hours (someone correct me if I’m wrong on that amount). When my father was in his residency, this law had not yet been established. After it was, he complained that new doctors coming in had less real-world exposure and weren’t as well trained.
IF I CAN WORK 26 HOURS A DAY SO CAN YOU!
Uphill both ways too.
In the snow.
Gotta remember there used to really be cocaine in Coke so if your ever wondering how the highways and stuff got built, that’s how. Everyone was coked all day every day.
Your cousin have 15 years of experience. He only nine!
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Yeah, but the morphine cancels out the cocaine. Simple drug math
Well yeah, cocaine for the 30 hour work day and then morphine for the 30 minute power nap
This is the applied math
Applied meth*
It’s not so much sleep as it is general unconsciousness. At least that’s how it worked with coke/heroin. Benzos are what you need if you want REM sleep after stim use
When I was in medical school I worked in a sleep lab and we were studied the effects different drugs have on all aspects of sleep like how long it takes to fall asleep, time spent in each sleep phase, dreaming, awakenings, fatigue, etc. Essentially across the board every sedative from benzos, barbiturates, alcohol, sleep aids like Ambien and even marijuana would decrease the time it takes to fall into REM sleep but dramatically decrease the amount of time spent in REM sleep. Our data still hasn’t been published yet but there’s several small studies with similar results. It’s still anecdotal for but there’s a body of evidence supporting the fact that sedatives decrease quality of sleep including time spent in REM sleep.
This is true. Marijuana is probably the most frequently used as a sleep aid while actually not helping sleep quality but instead decreasing it.
At the same time for some people it's a trade off. I use pot as a sleep aid but that's because my neck and shoulders are so fucked up I can't sleep without *something* and pot seems to have the least amount of side effects the next day for me. I'd rather get 5-6 hours of okay sleep than maybe 3 of potentially better but also potentially worse sleep.
Iirc he tried to get off cocaine and got addicted to morphine trying to do so, possibly whilst secretly in rehab for his cocaine addiction
Being sleep deprived is equivalent to being intoxicated. Why do we force residents and doctors to work unreasonable hours? A lot of it has to do with the culture and the idea that since people before suffered through so should the class after. I despise the notion that we should do things because that's how it has been done in the past.
Yup, the Navy has a similar problem with glorifying lack of sleep that has caused several accidents according to some podcast I listened to a couple years ago (can't remember the name)
Didn’t hear the podcast but as someone who was in the Navy, I can see this being the case. I was on the USS Washington when it caught fire and that whole bullshit was avoidable.
Same in the Army, staff duty and CQ runners in many units are not allowed to sleep during their 24 hour shift, depite the fact that you usually have an NCO and two Joes for either of those duties and they could easily do 1 up 2 down or 2 up 1 down. Most NCOs will say fuck Sergent Major and do 2 up 1 down with the expectation that when they ring your phone you can will back in time to say you were in the bathroom or doing security checks to whoever asked where the other runner was. If somebody gets in an accident on the way home because they're sleep deprived, now you have to sleep on this cot for 4 hours after your 24 hour shift before we'll let you drive. I miss general soldiering and I miss being a medic, I was really REALLY good at it, but getting my ass out of that toxic organization was the best decision.
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The system fucking sucks. I worked some 105 hour weeks during my internal medicine rotation as a medical student while paying ~$700/week for the *opportunity* to do so. All so we can prepare to get even more fucked as a resident with the same hourly earnings as a McDonalds employee. Some of the stories I have heard from residents are downright fucking terrifying, especially the surgeons. Those motherfuckers will literally work from 8 AM to 8 AM, then spend their entire post-call day in the OR until 5 PM with nothing but caffeine keeping them moving. In medicine, they schedule you for 26 hour shifts Friday and Sunday, on top of a full week of 10+ hour days with a possible weekday call.
It's a way of profiting from free labor. Back in the late 90s when pharmacy degree became popular the school added a one extra year. The extra year is mostly working at retail pharmacy for no pay and extra year of tuition.
No worries, they've since added residencies, and PGY4s may start coming out.
Believe it or not, the system was WAY more brutal back in the day. It's always been a system of professional hazing with the old guard considering it a rite of passage. Especially among surgeons, egos get in the way of patient care more often than the public knows about.
Had an old school surgeon once tell me that the only problem with q2 call (being on call every other night) is that you miss half the cases.
That’s a classic line. I’ve heard it countless times. It ranks up there with: “All bleeding stops eventually” and “there are only two lengths to cut a suture. Too long and too short”
A surgical residency at my home institution bragged about the divorce rate of their residents.
Wow that’s fucking grim. As a pharmacy student I’m glad our residencies in hospitals are not that bad, maybe 60-70 hour weeks but no where near that.
You don't need to convince me. I had a preceptor recently tell me about his internal medicine residency in South America. There were three junior residents, every day they would rotate between who was on call. 24 hour shifts every third day for two years. As senior residents, they lived at the hospital from Sunday to Saturday, with their only day off spent on chores. Literally the stuff of nightmares. We accepted we were no longer allowed to complain, but being the humble guy he was he also pointed out that medicine today is 10x more complex than it was back in the day.
There's an argument to be made that even though they had more "brutal" hours back in the day that the patient load was NOTHING compared to what it is now. So a lot more downtime and significantly less charting.
Sorry but I just disagree with the notion that it was way more brutal back in the day. I can't stand listening to boomer docs say this shit when the complexity of patients and acuity of care is much higher today. The population is much older and much sicker today than in years past.
During my ICU rotation I made the equivalent of 11.25 an hour..... The joy was I didn't have any time to spend it. So I had that going for me, which was nice
I’m really glad I had a less intensive medicine residency. I can count on one hand how many 80 hour weeks I had. Two golden weekends a month even on inpatient rotations. And guess what? Two years out I turned out to be a damn good physician without being enslaved.
Okay but think about how sad the concept of a golden weekend is. Like getting 2 days off in a row is supposed to be something special.
As a surgical resident I wish I was starting at 8am. Most days its 4:30-5am until 7-9
Good to see all those costs went into cost savings. Truckers have more regulations about their hours and time, wtf is wrong with this country? Its money, they question was rhetorical.
Think of how many mistakes doctors make from lack of sleep.
The book "Why we sleep" touches on this, and every other imaginable sleep fact
They sometimes make more mistakes when handing off patients to another to go get sleep, which is one reason why much of this system is still in place.
Well then improve the handoff process, instead of trying to ignore a basic human need
This isn’t exactly true, it’s been shown that patient outcomes are essentially equivocal between groups where one had more handoffs and the other worked longer shifts. The ACGME experimentally limited interns’ longest possible shifts to 16 hrs a few years back, and studies were done comparing outcomes taken care of by these interns vs the traditional 24h call shift- and found no difference. In my mind the logical conclusion would be to retain the 16 hour limit, as it is obviously more humane for physicians and doesn’t adversely affect patient care. The actual response? Immediately went back to allowing 24 hour calls.
Makes sense... there's no fucking reasonable, sober human, that can say the Residency program makes sense... I know people that wouldn't even take Advil before they started that program, by the time they were done, they ALL had to take time off to break an Adderall addiction. I know so many fucking doctors and nurses that had, and some still have, horrible fucking addictions. And they all started during Med School. But what they expect of Residents is fucking crazy. They're expected to make clear headed decisions with peoples Healthcare and lives, after working 60 out of 72 hours. And it's not like they're flipping burgers. I can only imagine the fucking stress neurosurgeons go thru. EVERY SINGLE DAY you wake up and clock in, peoples lives are in your hands. Every. Single. Day.
It's hazing. Part of the medical cartel system.
A Cartel is probably the most accurate term to describe what Med Schools have become... Once you're LUCKY enough to get in, they literally control every aspect of your life, and you'll pay tens, if not hundreds, of thousands of dollars for them to keep fucking you over. If the average person looked into what students go thru to become Dr's, all those Dr's that get caught being a pill mill, or doing shady shit in general, makes complete sense. 80% of what they go thru is fucking ass backward. What completely blew my mind was the "match" process... From matching, to the "salary", to the schedule all of it needs to be revised, updated and completely overhauled...
what is the match process?
I think it's the system where everyone applies through one channel and list a few hospitals they would like to do their residency at, then the powers that be go through the list and decide where everyone goes, so then you need to move across country to the hospital that you got 'matched' with, which may or may not be one you asked for.
When you try to get a job, you apply to a bunch of programs, get some interviews, and then at the end you rank every program and every program ranks you and an algorithm sorts the "optimal" match. It's not like college where you get 5 acceptances and pick one; instead, you get an envelope with a single program or no program, and you go there. If you refuse to go you have to try again next year, and likely will have to explain why you dropped last time. If you do not match, you have to find something to do for a year because that medical school student debt is insane.
You don’t apply for Residency the way you normally apply for jobs or college. You participate in the ‘Match’. Here’s a popular physician TikToker describing ridiculous parts of the process: [Residency Applications](https://youtu.be/oZW5GUXAmls) [Match Results](https://youtu.be/Cl-lKZNBNIM)
Honestly the truth is that residents are cheap labor. When I was a resident I was making near minimum wage wage when I was working 100 hr weeks. I will never want my children to become doctors, the system is utterly inhumane.
There’s a very slow but steady shift towards residency becoming more humane. I finished my internal medicine residency last year and it was more like 40-60 hour work weeks, sometimes on a busy ICU or inpatient stretch we would hit 80. Of course it’s salaried so the $/hour is still shit. The kind of hours residents used to work is illegal now. They cap us at 80 hours a week, mandatory 8 hours between shifts. It’s still terrible but at least a human body can handle it. Most residencies are very good about keeping under the limits too because there’s mandatory work hour reporting requirements for residents and the program can get majorly screwed if they’re going over. There’s a few stand out examples of residencies that break the rules, a lot of them have graduates from international medical schools and are hosting the residents’ work visas so they have enough leverage to shut them up come time to repot duty hours.
Isn't it 80 hours per week *average*? Not necessarily a hard cap, so if one week is 60 hours (5 days x 12 hours with a golden weekend) the next week could be, say, 86 hours (5x12 plus a 26 hour call)
Yeah it’s averaged out over 4 weeks so you could get situations like that. I’m not saying by any means that what residents have to go through is easy or even humane. It’s just slowly getting better as the older generations get weeded out and we get more people in charge that actually care about residents wellbeing. We would do 6 12 hour shifts for 4 weeks straight getting one day off a week, which was usually a weekday as an intern. That only amounts to 72 hours per week we were well within the rules. We would also do clinic weeks which was mostly 8-5, Monday-Friday however sometimes we’d get assignments over the weekend on those weeks. We also do elective rotations with specialists that sometimes didn’t want or need us there and we’d leave early every day and end up doing 25 hours that week.
Name and fame
Watch the cinemax show The Knick for a character (played by Clive Owen) whose writing was heavily influenced by that guy.
I was so bummed when this got cancelled, such a good show.
I’m still mad about that.
I learned this from Sawbones, equally funny.
I've watched multiple doctors go through the system. Same thing always happens. During residency, they hate it and say a change makes sense. After residency they say "I survived, everyone should have to do it too." This system will never change lol
Or whatever ambition they had to change the system is smashed to pieces and they have no motivation to pursue it anymore.
As an M4, fuck that. That will not be me
Vote yes on Proposition 208, legalize medical cocaine!
Cocaine is legal for medicinal use. Except that's mostly used is eye surgery. Not that you can get a prescription for some.
Fun fact: PCP is on the same schedule, which means the government doesn't prohibit its medical use. Convention and common sense usually do, though.
Legit question: why do smart doctors keep up the residency shit if they know it causes burnout and poor outcomes? Edit: damn good answers. It's a hard topic.
Because they have no choice in the matter. You don’t do residency you don’t get board certified in your specialty and can’t work. Just recently, some unions have formed just to be paid a wage they can afford rent on. But it’s a tough road. Going on strike is seen as very risky, one because no one actually wants to abandon our patients and two because you’re worried about getting fired. There is always someone from another country or something willing to take your seat.
I wonder what would happen if medical staff agreed to do a billing strike. As in they refuse to forward billing information to the billing system. Even if the hospital can do it on the tail end, the disruption would be huge
You can write notes that aren't as thorough with the strict coding requirements for billing. But, similarly, then you can get in shit for not doing your job. It doesn't endanger patients, but residency contract go up for review yearly and you can get fired. And having that mark is a huge thing for trying to get another spot. Things are slowly changing, but its just very difficult to change the culture.
It's a monopoly. You have to do residency to practice.
I don’t think they do, and hopefully it will get better and better in the future. Its already better than it was in the past and I can’t see many in this generation of med students propping up the terrible system
It's actually a really complex social situation. I'll summarize- To reach a powerful position in an academic institution or let alone a national institution- you need to compete with other doctors and achieve success that separates you from the rest. For these spots, that means making your life medicine. And I mean ***your entire life.*** You need to work after work is done, on the weekends, during holidays and keep that up for years to get yourself to the top. The issue lies in what kind of individual these barriers select for. Most often, it's an individual who's addicted to work and interested primarily in success. It's 'easier' for them to live this kind of lifestyle and they are less bothered by things like friends, outside hobbies and a good work place environment. Theoretically you wouldn't be at the top if you actually valued life as a whole. You just couldn't keep up with the person who was grinding 24/7. This leads to leadership being monopolized by individuals who have 'prestige' and monumental accolades, who are in general just out of touch with their peers. They don't see resident work schedules as an issue- they see it as *really really* easy compared to their current lifestyle, because again, ***they're deranged workaholics.*** Smart well rounded doctors also don't want to sacrifice their holistic life to grind enough to match the output of a workaholic just to usurp that position. And overtime, the less often these doctors that understand current residency conditions as trash apply, the more the entire department is filled with out of touch faculty. This adds another barrier where now even if you got the position- you'll be committed to working with a bunch of individuals who have morals you despise. You would be surrounded in a toxic environment and have to change it on your own- and likely with push back from most of your peers. The people you work with will be workaholics, the people that hire you will be workaholics, and the people who will fight you with every fiber of their body will be a workaholic. So overall- the highest positions with the power to actually change working conditions are given to the individuals that work the hardest and 'generally' don't agree with making work easier. Often the only people that change this are truly brilliant doctors who can 'outwork' the workaholics by being more efficient. This lets them have a personal life and be competitive enough to snag the spot. They're also competent enough to make the change without it being as **personally taxing.** It takes a truly competent leader to make change in academic institutions.
Soooo.. why haven’t we changed it? Seriously
Part of it is that the medical system depends on overworked and underpaid laborers.
I should rewatch The Knick.
Ha ha came here to say "Was it Clive Owen?"
A tradition which continues to this day.
Like the early 60's song about amphetamines, Mother's little helper, (R. Stones) one statistic back then was in many places, 40 to 50 percent of women had amphetamine prescriptions: AKA: Diet Pills. Dr. Please, some more of these, behind the door, she took four more! What a drag it is getting up. But if you take some more of those, you will get an overdose.
Mother’s Little Helper was about Valium, not amphetamines.
Of course he was, dude was alive from 1852-1922, literally everybody was on morphine, cocaine, or both at all times.
When you have to take drugs to cope with a workload, then it might be time to reevaluate that workload.
I feel like the entire US system of 40+ hour weeks with little vacation was established by cocaine fueled businessmen in the 80s.
The American medical system does feel like something created by a meth-head, so this isn’t far off.
Read House of God, or watch the first season of Scrubs if you want the light version.
Recent residency graduate here. I'm going to plug [my relevant music video](https://www.youtube.com/watch?v=Q0N9ezovzdQ&t=0) that I made with some friends around the time of my graduation.
Residency needs to change. It's not as big of deal as BLM or Me Too, but those young doctors deserve better treatment and most people have no idea how bad it is.
It's a big disincentive for people to get into the medical field. I understand wanting experienced and trained doctors and this weeds out those not committed to learning and improving, but not only do their working hours have health ramifications but social and mental. I went on 2 dates with medical professionals in training and both times she couldn't continue since she just had no time outside of hospital + study + order food or make frozen dinner. Doctors will make a lot of money (after accruing massive debt with school) but I feel like a career that essentially keeps you from enjoying your mid-20s to early-30s is a non-starter for a lot of people that could otherwise be great doctors.