I’ve often wondered what the reason is for this. On the surface it seems dangerous and just plain dumb. Only thing I can think of its a form of hazing to weed out the weak candidates. The other (darker) possibility is that under these conditions, the interns routinely (and inevitably) screw up. So, the senior Doctors have something to hold over their heads in the future—just in case they get out of line.
There are three lines of thought.
1. A physician must be relied upon to make good decissions day or night rested or not. Internship and residency is a time to teach young doctors to think even when physically, they are at the end of their rope. I can vouch that they do teach skills that are valuable when practicing medicine for prolonged hours or while suffering with the flu.
2. There are so many hours to teach a resident before they are out on their own. Sleep is wasting valuable teaching and learning time. The more patients seen, the more learning opportunities.
3. The staff physicians went through the same torment, there is no reason why the kids should get off easy. This is pretty close to the reasoning behind hazing, and the hardest to justify.
Nobody wants to see someone hurt, the resident nor the staff physician. The staff physician has plenty to hold over a residents head. They are god of the call schedule, all-mighty ruler of patient load and can ruin a residents future at a whim if they so desire. I could tell you horror stories about a psychotic staff gynecologist who to the dismay of generations of resident worked until he was 80.
It’s not really a weeding out. Most of that happened long ago. What it boils down to is that somebody has to take care of patients overnight. Someone has to admit them, as well.
The single best time to get to know a patient is when you first admit them. You spend by far more time getting to know all the intricacies of a pt’s medical and personal history this way. So you develop a strategy to address their problems in the middle of the night, collapse after you’ve set it in place, and come back the next day knowing the patient. You’re getting attending feedback in the morning, as well. It’s supposed to be a learning opportunity. How well this works when you’re falling asleep in the middle of a conversation at noon the next day is up for debate...
A lot of these longer hours could be served with nightfloat systmes or more days off, but that requires hiring more residents and more hands in the pot.
I’ve figured it out. Right now I’m working for about $10 per hour.