Obviously not every moment of every hour in a residents day is deep clinical thinking with high cognitive load, but we’re definitely not “zoning out” when making medical decisions. Patient statuses change very quickly and very often in the hospital, and every problem should be re-evaluated like it is a fresh concern. Decisions can be made quicker with more experience but you’re expected to be “on” all the time. Plus, lots of things contribute to cognitive load outside sheer medical decisions - social work, dispo issues, patient preferences, etc. Luckily my residency is closer to 60-70 hours a week but 100 is still common.

Remember - the 80 hour a week limit is not a max limit. It is the max hours per week AVERAGED OVER 4 weeks. You can easily work 100 hours this week if you do 60 the next.