me: I heard I had chicken pox as a baby, even before I left the hospital.

One of the benefits of my current rotation, cardiology, is that it's not at my university hospital.

There's only one cardio rotation at University Hospital, so because cardiology was lower on my list of Most Wanted Rotations, I got sent out to Smaller Hospital 40 minutes away, which has a big cardiology department. (It's not a small hospital, exactly - their CCU alone has 17 beds. It's just smaller than most I've been to.)

So I'm a bit out of my comfort zone, because I don't know the hospital or their computer systems or the way they practice pharmacy. When I got there, I found that there are a number of other students from another nearby pharmacy school who do all of their rotations at Smaller Hospital. They, of course, know the system very well, and they were happy to show me around.

But it's interesting to see how pharmacy is practiced differently. For example, at this hospital, the pharmacy (the staff pharmacists, not the clinical pharmacists) is responsible for doing about half the Coumadin and antibiotic dosing. As such, they routinely write orders for certain antibiotics, INRs, and antibiotic levels. Their stewardship program consists of monitoring all the restricted antibiotics (and then not being able to do anything about it unless they're consulted. It's a pretty ineffective stewardship program). Another thing I've noticed is that they're big on loading doses. They load Coumadin (which I'm pretty sure is flat-out wrong, even though they have their adaptations and apparently haven't had any major problems). I've also seen loading doses of Vancomycin and aminoglycosides. That's something I almost never saw at University Hospital, though it's not necessarily wrong.

And of course, sometimes it feels just like home. Their pharmacy, like all others, is in the basement. Clinical pharmacy there works pretty much the same as it does at University Hospital - you make recommendations to the intern and/or the residents, and you're responsible on rounds for knowing all about drugs. And the interactions among pharmacists, doctors, and nurses are about the same as what I've seen other places.

It's a little reassuring to know that some things never change. Next year I'll (hopefully) be doing a residency year, and my top two choices are 600 miles away from here. So hopefully, this experience will help me learn to adapt to a different hospital in a different place. The students from Other Nearby Pharmacy School have occasionally said that they wish they could do rotations in other places, just to see what it's like. I'm glad my school gives us that option.

Alb: If some of the terminology is above your head, refer to the comments for a bit of clarification from Shari. :-)

I very recently read the following article in the Los Angeles Times, The doctor is in -- but not for long. It reports a decrease in physician work hours from an average of 55 hours/week to 51 hours/week between 1977 to 2007. The study can be found for free here: Trends in the Work Hours of Physicians in the United States by Staiger et al. in the Journal of the American Medical Association (JAMA).

Now, both articles above interpret this decrease in physician work hours as somewhat troubling, the LA Times almost "blaming" doctors for their newfound laziness (compared to teaching, law, and journalism). The study reports the decrease to be most prominent in younger physicians (defined as 45 or younger). The study concludes that this 5.7% decrease in physician work hours averaged over the 630,000 or so doctors in the 2007 workforce translates to losing about 36,000 doctors. That's pretty dramatic. 630,000 doctors to take care of over 300 million Americans is quite some feat.

I suppose I'm the devil's advocate as I find it irritating that the study concludes the decrease in physician work hours to be worrisome for the US health care. To me, it's overdue and about time for this decrease in work hours.

Let's put the hours into perspective. Assuming a 5-day workweek, 55 hours/week translates to 11 hours/day. That would be like getting to work at 6am and not leaving until 5pm, or getting to work at 7am and not leaving until 6pm, etc. Again assuming a 5-day workweek, 51 hours/week translates to just over 10 hours/day; so 6am until 4pm, or 7am until 5pm, etc. If you haven't noticed, that's still a lot of time spent in the office, and that's not including time spent commuting to/from work. The study also doesn't take into account all the paperwork and other aspects of being a doctor that are often done outside the office or from home. I believe that younger physicians are more tech-savvy and are more likely to utilize online resources and such from home.

The study correlates the decreased work hours with lower reimbursement rates in urban areas compared to rural areas. Let's address this. In urban areas there's often a "saturation" of primary care physicians. In more than one lunch or dinner panel with residents, some of them mentioned their concern over being (potentially) unable to find a job in an urban setting, and so sometimes decide to specialize. When you have more doctors in an area for a given population, each doctor sees fewer patients . . . and so likely works fewer hours. In contrast, rural areas have fewer doctors because fewer doctors want to practice there. And because there are fewer doctors, there's a greater need for them; thus, they work longer hours out of necessity to their patients and they well deserve to be reimbursed more for their increased work.

A point briefly mentioned in the study was the thought that younger physicians wish to have a more balanced lifestyle. As if that's a crime? . . . Is there something wrong to want to have time to spend with one's family and go to their children's events? Is there something wrong with wanting to take a vacation every now and then? Refer to the first point I made - that even with the reduction in work hours on average, it's still a lot of time at work. Times have changed since the 1970s. The rise of the two wage-earner family means that each wage-earner can afford to work fewer hours to support the family.

I remember reading a blog post on EverythingHealth by Dr. Toni Brayer called New Doctors - New Culture that hits at many of the points I've made. That post was written in 2008 and it continues to ring truer and truer every day. One of the top concerns of many of my female classmates is how to balance work with family - how can a doctor work so much and still be there for his/her kids? Something has to give.

So I ask: should the health of others be held above one's own health? Above the time one spends with one's own family and friends? Aren't doctors humans as well with very human needs and limits?

I think it's easy to forget that doctors are people too, that we're not all-knowing and unfeeling automatons. The reduction in work hours shouldn't be maligned, they should be welcomed as being more reasonable and more conducive to having a life outside the office. But certainly something has to be done to compensate those lost hours. The variables affecting the production of new doctors are complex and many (and I won't go into them here). But it all begins with a better health care system than currently exists in the US.