Are surgical residency hours really that much worse?

[dbeast]

Hey peeps, I'm considering applying into general surgery but I was initially hung up on the time commitment. Then, on my other inpatient rotations, I realized that the hours don't *seem* to be that much worse. On medicine, for example, the residents show up at ~6ish and stay at least until signout at 6pm. When I was on surgery, we pre-rounded around 5, and the latest cases each day were scheduled to start around 4 in the afternoon, and it was intentionally planned for those to be some of the shorter operations and we'd usually be out around 7PM. Call was Q4 on surgery compared to Q5 on medicine.

So, even though surgery was certainly busier than medicine, it wasn't too much of a stretch. If I'm going to be at the hospital at 6AM for medicine, why not get there an hour earlier to do a job I prefer?

But, I hear all these stories about impossible hours and I feel like I'm missing something obvious. Maybe my surgery rotation was at a program with less intense hours? Can somebody explain to me what it's *really* like to be a surgical resident? Or, can I expect 5AM-7PM six days a week with 1-2 days on call? Yeah, it's tough, but I think I can handle that. 120 hours per week? That's a different story...

Thanks for all the advice.

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[neusu]

I'll second this.

1) 80 hours is your limit in the hospital. That does not include reading for your cases tomorrow (which happens every day). While most programs do follow the rule, some don't.

2) The pace is much faster. Trauma, pre/post-ops going south, everything moves faster in surgery. All of this increases the stress of the 80 hours you are there.

3) Agreed, those who are concerned about hours need not apply. The work is done when it's done. If you are consistently not finished with your duties when it's time to go you need to work smarter or faster. It is entirely unacceptable to dump your work on to the person coming on.

 

[LucidSplash]

Ditto everything above.

Also, some of this is about personal preference. 60-hours a week of interminable rounding treating COPD exacerbations, DKA, kidney failure, CHF, etc? Please shoot me in the head now and get it over with. Alternatively I would accept some kinds of alternative torture like having my nails pulled out.

Taking care of surgical patients (who also have the above problems) but focusing on surgical diseases for 80-90 hours a week? Feels like shorter days than those on medicine above.

 

[KinasePro]

I never understood the "if you ask about hours, don't bother applying" mentality on the various SDN surgical forums. In real life, I hear surgery attendings and residents gripe and moan about thier schedules plenty, especially after they've had a nasty night on call. Still, the majority are happy, normal people. People don't actually treat work hour conversations like an elephant in the room in the real world, at least in my experience. Then again, I'm just an M3 so who knows.

Maybe the SDN skepticism stems from all those lovely premed threads: "IS IT EASY TO FIND PART-TIME, CONCIERGE PEDIATRIC CARDIOTHORACIC SURGERY JOBZ IN SAN FRANSISCO?!?11"

But IMO, I can't find fault in asking detailed questions about work hours, esp on a semi-anonymous forum. I'm willing to work my ass off to do what I love, but I also like knowing exactly what I'm signing up for. Can't fault OP for doing his due diligence to make sure he isn't surprised in a bad way when he starts residency.

 

[dbeast]

Ditto everything above.

Also, some of this is about personal preference. 60-hours a week of interminable rounding treating COPD exacerbations, DKA, kidney failure, CHF, etc? Please shoot me in the head now and get it over with. Alternatively I would accept some kinds of alternative torture like having my nails pulled out.

Taking care of surgical patients (who also have the above problems) but focusing on surgical diseases for 80-90 hours a week? Feels like shorter days than those on medicine above.

Thanks for the advice amigos... I totally agree with the whole idea of 80-90 hours of surgery > 60-70 hours of rounding (hence why I started this thread), but honestly 120 hours a week of anything is too much. I for one am glad to hear it's closer to 80 than 120. You guys are welcome to be the judge of whether that qualifies as worrying about hours or not.

 

[ACSurgeon]

Thanks for the advice amigos... I totally agree with the whole idea of 80-90 hours of surgery > 60-70 hours of rounding (hence why I started this thread), but honestly 120 hours a week of anything is too much. I for one am glad to hear it's closer to 80 than 120. You guys are welcome to be the judge of whether that qualifies as worrying about hours or not.

1- You should not care what we think. Ultimately, you take what we say and decide if YOU think you want/are able to do surgery
2- coming in an extra hour early and leaving 1-2 hours later, 5-6 days per week, makes a hell of a difference in lifestyle. It's not trivial. You're tired most nights when you get home, yet you still have to study/prep for cases, etc.
3- Essentially no outpatient months compared to medicine
4- exponentially more intense personalities and pace when compared to medicine. This can make residency seem much more difficult if you don't have tough skin.
5- 5 years vs. 3 years (although with fellowships after medicine the total number of years evens out)
6- With all that said, I'd do surgery again in a heart beat. When I chose surgery, I wanted to do something that I'd be happy doing even if I had to work long hours and be under paid. This is especially important in our times of uncertain futures in all specialties…

 

[mercaptovizadeh]

I think those of you who are jumping on the OP's questions regarding hours are missing the point. He isn't complaining about hours per se. He's basically asking if IM is doing ~70 hrs/wk and GS is doing ~80+ hrs/wk, why does GS have so much more of a "harder" and "malignant" reputation when it comes to hours. I think you've answered that partly that's historical and partly it's a matter of intensity (arguably MICU/CCU is intense as is surgery but wards and outpatient months in IM clearly are not as intense). The real question for the OP is whether he prefers the fast past "get to the point" mentality of GS when it comes to diagnosis + the procedural aspect of operating vs. the slower paced "let's run through the differential diagnosis" and "let's give her midodrine/octreotide and fluids and see if her creatinine responds tomorrow" approach of IM.

If you didn't check the peds forums, the OP is debating pediatrics + heme-onc fellowship vs. GS + peds surg fellowship. Seems he likes critical illness but hates general pediatrics and worries about the length of training of the surgical pathway.

 

[dbeast]

I think those of you who are jumping on the OP's questions regarding hours are missing the point. He isn't complaining about hours per se. He's basically asking if IM is doing ~70 hrs/wk and GS is doing ~80+ hrs/wk, why does GS have so much more of a "harder" and "malignant" reputation when it comes to hours. I think you've answered that partly that's historical and partly it's a matter of intensity (arguably MICU/CCU is intense as is surgery but wards and outpatient months in IM clearly are not as intense). The real question for the OP is whether he prefers the fast past "get to the point" mentality of GS when it comes to diagnosis + the procedural aspect of operating vs. the slower paced "let's run through the differential diagnosis" and "let's give her midodrine/octreotide and fluids and see if her creatinine responds tomorrow" approach of IM.

If you didn't check the peds forums, the OP is debating pediatrics + heme-onc fellowship vs. GS + peds surg fellowship. Seems he likes critical illness but hates general pediatrics and worries about the length of training of the surgical pathway.

Thanks for doing your research on my predicament... Ok, here's the story of exactly what happened, since I really do appreciate the fact that you're all taking the time to help me out. Read on if you're so inclined, I'll keep it short:

I did surgery as my first rotation ever of third year, and needless to say, I had no idea wtf I was doing or what to look for in a specialty. All I knew is that the hours were very intense but the job was *pretty* fun. The interns were new so they wanted to do everything, and I kind of just stood around holding retractors and trying to stay awake. In retrospect, I doubt that was a very accurate example of surgery. Then I got to IM /ambulatory and realized that rounding and clinic just ain't my style (your "check the creatinine tomorrow" example is spot on).

So here I am, months away from deciding my career, and I'm in a bit of an identity crisis since I haven't really found anything (except that I like working with kids).

Fast forward to just this month, a research mentor invited me to do a bone marrow harvest, which is in the operating room under general anesthesia, and he let me practically run the case... Hands down the coolest thing I've ever done, I'm talking in my entire life. Problem is, I'm not sure if it was being back in the operating room with plenty of responsibility in a "surgery", or if it was the idea of treating a patient's cancer that really pumped me up about it. Whatever it was that caused the feeling, that's what I want to do for my career.

I understand that I'm the only one who can really answer these questions, but I do appreciate the input so far. Here are a couple ideas that I invite you all to shoot down:

- Be a general surgeon at a community hospital and kind of be like a "family med" type surgeon, taking all cases, kids and adults, and likely getting a bit of continuity since I'd have to do follow-up appointments too. The con is the lack of complexity of the cases, and minimal teaching opportunities.
- Do peds IR; I know this exists, but I haven't found much practical info like job markets or where I can practice, since it is really subspecialized. This option is currently the biggest mystery to me.
- Sack up and do peds heme/onc with a bone marrow transplant fellowship and hope that I get by with the very occasional procedure. I can make the argument that the rest of the job makes up for the lack of hands-on work. Peds cards/peds GI also kind of fall into this category.
- Be a total savage and do 9-10 years of peds surg residency. I'll be graduating when I'm 29 years old and I can't help but feel... old. On top of that, it's 10 really tough years, and even though most other things I'm considering are 6-7ish, those years are spent with an easier schedule than surgery. This feels like the least feasible option for whatever reason.
- PICU is kind of out because even though I like the acuity, I'm not a fan of the looooooong rounds.
- Anything else I'm missing?

Thanks again, amigos.

 

[ram006]

- Be a general surgeon at a community hospital and kind of be like a "family med" type surgeon, taking all cases, kids and adults, and likely getting a bit of continuity since I'd have to do follow-up appointments too. The con is the lack of complexity of the cases, and minimal teaching opportunities.
- Do peds IR; I know this exists, but I haven't found much practical info like job markets or where I can practice, since it is really subspecialized. This option is currently the biggest mystery to me.
- Sack up and do peds heme/onc with a bone marrow transplant fellowship and hope that I get by with the very occasional procedure. I can make the argument that the rest of the job makes up for the lack of hands-on work. Peds cards/peds GI also kind of fall into this category.
- Be a total savage and do 9-10 years of peds surg residency. I'll be graduating when I'm 29 years old and I can't help but feel... old. On top of that, it's 10 really tough years, and even though most other things I'm considering are 6-7ish, those years are spent with an easier schedule than surgery. This feels like the least feasible option for whatever reason.
- PICU is kind of out because even though I like the acuity, I'm not a fan of the looooooong rounds.
- Anything else I'm missing?

A few things -

1. I think it's important to realize you're not the only person dealing with an identity crisis. I went through the same thing as a medical student. The curriculum at my medical was traditional and outdated so I felt incredibly rushed and uninformed when I made my decision to pursue surgery.

2. Peds IR may exist, but the job market will most likely not support you being exclusively a "peds IR guy." It's just not all that practical. You would have to like all types of IR as well as diagnostic radiology (which most students forget)

3. Peds surgery is an incredible field. One that I find myself drawn to as well. But you are right, the training is 9-10 years if you match on the first try. As I'm sure you know already, the match rate is usually below 50%.

4. Peds GI seems cool, a friend of mine from intern year didn't end up matching into Surgery (he was a prelim) and switched to Peds. He seems very excited about the future.

5. Probably most importantly, you have to realize you're not old. Older than boy genius that started college at 16? Yes. Older than the average medical student? Yes. Old in terms of your actual life span? Hell no. I would expect to have a career of about 30 years. You're a bit older than I was at graduation but you're still going to work for over 20 years. You should make those years count.

 

[WentForitandWon]

First, a little about hours. . . . .

surgery residency is like a band of brothers (and sisters). Everyone needs to work together. Sometimes the system is going to hurt you. you will feel overwhelmed sometimes; but it is the kind of person who can drink a cup of coffee, take a deep breath, and push on through that is successful. I've done the 100 hour work week and I've worked a few trauma and SICU months that had me at the 80-90 hour average for the month. Does it suck? hell yes. did your body, and maybe your relationships suffer a little? maybe. is it getting better? most definitely. Those kinds of hours are fading fast with shift work systems and night float, but occasionally you will have a week that is really that busy. what any surgical residency wants is for a resident to show-up and perform competent and efficient work without complaining. when you transition care to someone else you should do your best to make sure there is as little left not completed as possible. The icing on that cake, is if you can find a way to help one of your comrades (stay late to do the case that is about to start, finish up the consult that came in before signout, etc.) . Hopefully they will return the favor for you one day. If you do all of that stuff and you are hanging out with the residents in the lounge then you have more than earned the right to bitch a little about the ****ty consults you got from the ER or IM the night before and the fact that you haven't eaten in 13 hours.

I'm near the end of my residency, but here are two quick facts from my intern year.

I lost 15lbs in the first 2 months because I never had time to sit down when I was at work. when I had time to eat it was usually the highest calorie thing I could find (hamburger, french fries, a medium pizza folded in half and eaten in a stairwell).

I fell asleep standing up while rounding on patients and even in the OR quite a few times.

would I change any of my experiences for a little more rest and time to eat? absolutely not. I have learned and done so much, and I am excited to be nearing the end so I can get started living my life. Also, a little suffering lets you know what your limits truly are. I can proudly say that I have not yet reached the point of saying I can't push through.

Now, onto the main even!

You like kids and you want to do surgery. Have you ever thought about ENT or plastics

ENT - 5 year residency with 1 year peds fellowship. myringotomy tubes, tonsillectomies, sinus surgery all day, appointments for allergy workups and nasal obstruction are your bread and butter.

upside: can function in private practice with a loose hospital affiliation, great salary and reimbursement, can treat adults and kids, can still do general ENT if you want (head and neck cancer, etc), high volume of cases in a day with the bread and butter, few true emergencies that will get you out of bed. On call as an attending it will depend on the arrangement you have with the ER. In my hospital ENT does not cover facial trauma, all turfed to plastics. Can do some cleft palates, but most of that goes to plastics unless you are in an underserved area.

downside: can get a little pigeon holed with the bread and butter cases. peds ENT's I have worked with have the same 3 cases 90% of the time.

Residency: highly competitive subspecialty surgery. high board scores, research, etc.
intern year can be tough as you rotate on other services. Run the floor on the inpatients. ENT 2-5th year get a lot better. Hours are pretty reasonable, more in the 60-70 range.


Plastics: 6 year residency followed by 1 year fellowship in peds craniofacial surgery. This allows you to work on cleft palates/lips, and a huge list of other facial abnormalities.

upside: work with kids every day, a lot of continuity, you could start today on some of the kids and by the time you retire you would have just finished their last revision rhinoplasty, few true emergencies on call at night (for peds).

downside: pretty much can only exist in association with a large university medical center. can't really run a mixed practice (cosmetic, peds, hand, general plastics etc.), re-imbursement (you will be paid well in comparison to others but if making maximum $$$ is your game, this is not for you). If you cover ER call you may get a fair amount of peds facial/adult facial trauma at night depending on how that is done in your institution.

Residency: highly competitive subspecialty surgery. Average applicant has a USMLE step 1- 240-250, plastics research, away rotations, and good letters. if you were thinking of doing PRS, taking a year off to do research for an applicant who decided in their 3rd year is not unheard of.
1.5-2 years on general surgery or non plastics rotations during the first 3 years . General surgery call year 2 and 3 can suck depending on the program, but the rotation schedule usually does not kill you with the worst that GS can offer (not a lot of transplant, Hepatobilliary, etc at most places). Plastics call is mostly home call but you may be driving in from home a lot depending on the ER with no post-call day afterwards. total work hours as a plastics 3.5-6 highly variable but generally 60-90/week.

Good luck

Thanks for doing your research on my predicament... Ok, here's the story of exactly what happened, since I really do appreciate the fact that you're all taking the time to help me out. Read on if you're so inclined, I'll keep it short:

I did surgery as my first rotation ever of third year, and needless to say, I had no idea wtf I was doing or what to look for in a specialty. All I knew is that the hours were very intense but the job was *pretty* fun. The interns were new so they wanted to do everything, and I kind of just stood around holding retractors and trying to stay awake. In retrospect, I doubt that was a very accurate example of surgery. Then I got to IM /ambulatory and realized that rounding and clinic just ain't my style (your "check the creatinine tomorrow" example is spot on).

So here I am, months away from deciding my career, and I'm in a bit of an identity crisis since I haven't really found anything (except that I like working with kids).

Fast forward to just this month, a research mentor invited me to do a bone marrow harvest, which is in the operating room under general anesthesia, and he let me practically run the case... Hands down the coolest thing I've ever done, I'm talking in my entire life. Problem is, I'm not sure if it was being back in the operating room with plenty of responsibility in a "surgery", or if it was the idea of treating a patient's cancer that really pumped me up about it. Whatever it was that caused the feeling, that's what I want to do for my career.

I understand that I'm the only one who can really answer these questions, but I do appreciate the input so far. Here are a couple ideas that I invite you all to shoot down:

- Be a general surgeon at a community hospital and kind of be like a "family med" type surgeon, taking all cases, kids and adults, and likely getting a bit of continuity since I'd have to do follow-up appointments too. The con is the lack of complexity of the cases, and minimal teaching opportunities.
- Do peds IR; I know this exists, but I haven't found much practical info like job markets or where I can practice, since it is really subspecialized. This option is currently the biggest mystery to me.
- Sack up and do peds heme/onc with a bone marrow transplant fellowship and hope that I get by with the very occasional procedure. I can make the argument that the rest of the job makes up for the lack of hands-on work. Peds cards/peds GI also kind of fall into this category.
- Be a total savage and do 9-10 years of peds surg residency. I'll be graduating when I'm 29 years old and I can't help but feel... old. On top of that, it's 10 really tough years, and even though most other things I'm considering are 6-7ish, those years are spent with an easier schedule than surgery. This feels like the least feasible option for whatever reason.
- PICU is kind of out because even though I like the acuity, I'm not a fan of the looooooong rounds.
- Anything else I'm missing?

Thanks again, amigos.

 

[Pir8DeacDoc]

That's a great thought about pedi ENT. I'll add a few tidbits because it might fit nicely for the OP.
Intern year is intern year. Hours, etc are about the same. Hours of the last 4 years are in the 60-70/week range. Hard work but doable.

I'll add a few things to the bread and butter stuff mentioned above. pedi ENTs are the absolute masters of the airway. Depending on your set up they will do pedi trachs and will manage laryngomalacia, tracheo/bronchomalacia, subglottic stenosis, etc. Can be a lot of NICU consults for ventilated kids (CP, prematurity, down's).

Depending on your fellowship, lips/palates are fair game. The east coast is very PRS dominated for these cases and the west coast, I am told, is more open to ENT's doing those cases. My mentors were west coast trained and both did lips/palates in fellowship but not in practice (east coast).

Pedi ENT would do sinus surgery, but this is very rarely needed except in CF kids.

Of course pedi ENT will see lots of neck masses of all varieties.

Pedi ENT is an excellent field. To practice the full spectrum of pedi ENT you'd want to be in an academic hospital. You can certainly do private practice but it would likely involve things a general ENT would do (tubes, tonsils, etc).

Good luck with your decision making. PM me if you'd like to know more about ENT.

 

[dbeast]

Thank you all for the advice... I'm excited to give it all a thorough read when I get home from the hospital. One other quick thought popped into my head- anybody know much about peds ED? (I know, not the right forum, but maybe you've heard from people)

 

[DermViser]

Hey peeps, I'm considering applying into general surgery but I was initially hung up on the time commitment. Then, on my other inpatient rotations, I realized that the hours don't *seem* to be that much worse. On medicine, for example, the residents show up at ~6ish and stay at least until signout at 6pm. When I was on surgery, we pre-rounded around 5, and the latest cases each day were scheduled to start around 4 in the afternoon, and it was intentionally planned for those to be some of the shorter operations and we'd usually be out around 7PM. Call was Q4 on surgery compared to Q5 on medicine.

So, even though surgery was certainly busier than medicine, it wasn't too much of a stretch. If I'm going to be at the hospital at 6AM for medicine, why not get there an hour earlier to do a job I prefer?

But, I hear all these stories about impossible hours and I feel like I'm missing something obvious. Maybe my surgery rotation was at a program with less intense hours? Can somebody explain to me what it's *really* like to be a surgical resident? Or, can I expect 5AM-7PM six days a week with 1-2 days on call? Yeah, it's tough, but I think I can handle that. 120 hours per week? That's a different story...

Thanks for all the advice.

General Surgery as a medical student is NOTHING like General Surgery as an actual intern/resident. As an MS-3, you don't nearly do as much **** as the surgical intern has to do, you just THINK you do. Most surgery teams know that most students don't want to do surgery hence the expectations for students is ridiculously low. Surgery is one of those fields where you truly have to LOVE surgery in order to be able to get thru it, bc you will be living, breathing, and eating Surgery for 5 years. This is not like this even in IM, where at least some elective months are "easy". There are no "easy" surgery months in General Surgery residency. There's a reason that Surgery looks down on other specialties, esp. the ROAD specialties, bc the level of dedication required is SO much higher (I'm not talking about just time here) than most other specialties. Read the front of Surgical Recall regarding "The Perfect Surgery Student" esp. the term used HAMMERHEAD. Now apply that to 12 months of the year instead of just 8 weeks.

 

[neusu]

I never understood the "if you ask about hours, don't bother applying" mentality on the various SDN surgical forums. In real life, I hear surgery attendings and residents gripe and moan about thier schedules plenty, especially after they've had a nasty night on call. Still, the majority are happy, normal people. People don't actually treat work hour conversations like an elephant in the room in the real world, at least in my experience. Then again, I'm just an M3 so who knows.

Maybe the SDN skepticism stems from all those lovely premed threads: "IS IT EASY TO FIND PART-TIME, CONCIERGE PEDIATRIC CARDIOTHORACIC SURGERY JOBZ IN SAN FRANSISCO?!?11"

But IMO, I can't find fault in asking detailed questions about work hours, esp on a semi-anonymous forum. I'm willing to work my ass off to do what I love, but I also like knowing exactly what I'm signing up for. Can't fault OP for doing his due diligence to make sure he isn't surprised in a bad way when he starts residency.

We have issue with the "if you ask about hours" crowd because their underlying, fundamental interest is perpendicular to ours.

We, as surgeons, as physicians, would love to spend 24x7 in the hospital for our sick patients who need it. We feel obligated to. It took the work hours restriction to keep us from doing that.

While I agree, the restrictions are a good thing to keep employers from abusing their employees, in medicine, it often doesn't work that way. We still stay late. We cover longer than we "should."

For those of you who see medicine as a job. As shift work. You fundamentally don't get it. We don't want you.

 

[DermViser]

We have issue with the "if you ask about hours" crowd because their underlying, fundamental interest is perpendicular to ours.

We, as surgeons, as physicians, would love to spend 24x7 in the hospital for our sick patients who need it. We feel obligated to. It took the work hours restriction to keep us from doing that.

While I agree, the restrictions are a good thing to keep employers from abusing their employees, in medicine, it often doesn't work that way. We still stay late. We cover longer than we "should."

For those of you who see medicine as a job. As shift work. You fundamentally don't get it. We don't want you.

This post, my friends, encapsulates why millennial medical students are storming in droves towards the ROAD specialties and those specialties not in the mnemonic with a better lifestyle. Keep in mind that neusu is a neurosurgery resident, but this mentality and work ethic is present in most surgical attendings, esp. in academic medical centers.

There are some specialties in general surgery that are much better in lifestyle with great compensation but just remember that everyone else in your general surgery residency class is gunning for those specialties as well, and thus there is a sizable and real chance that you may be "stuck" doing general surgery for the rest of your life.

To the OP, the attrition rate of general surgery is 20%, even with work hour restrictions and it's not likely due to the hours:
http://skepticalscalpel.blogspot.com/2012/06/why-is-attrition-rate-of-general.html
http://www.ncbi.nlm.nih.gov/pubmed/20739854

 

[ram006]

I think some good points have been made in addition to the tired, worn-out, chest pounding display of bravado some residents/attendings seem to be proud of. No one thinks your cool because you spend all your free time in the hospital and mock people who don't want that life. It's toxic and why no one wants to be a part of your club (regardless of whether they are in your specialty).

In my experience the past few years, most of those guys seem to be the type that were unpopular in high school or desperately trying to be jocks. One Ortho resident in particular likened the hard-core, goal oriented mentality of orthopedics to college sports, which I agree with in many respects based upon my experience with D1 football, 4:30AM training sessions and playing with a dislocated thumb/(insert injured extremity here). His experience, however, was based on division III tennis. It literally made me "lol" and subsequently "rofl." That's not to say division III sports aren't legitimate but c'mon... I'm sure pushing through that tennis elbow really made a man out of you, my 62 year old father in law is in the same boat. These people are just wired the way they are. There's no point in arguing with them, you just ignore them and do your job.

The reality is, some surgical specialties - no matter how hard the ACGME tries - will never be able to make a schedule work with residents "only" working 80- hours. It's the truth and you should be honest with yourself. If you check out at 5, you're usually screwing someone over. People quickly notice which interns dump a bunch of stuff on them and which don't. This can be particularly frustrating when you consider the hour restrictions have basically reduced the PGY1 experience largely to a non operative year at most large academic centers.

I also disagree with the notion you have to "eat, breathe, and sleep" surgery for reasons explained in the first paragraph. I work as long as there is work to be done, and I go home. Period. After intern year, though, I found that staying late was more and more often because I was in the OR rather than seeing consults and writing H&Ps. That's made a huge difference.

 

[KinasePro]

We have issue with the "if you ask about hours" crowd because their underlying, fundamental interest is perpendicular to ours.

See, this is the straw man that bothers me. You assume that students aren't willing to provide whatever care is necessary for their patents, just because they ask about what the hours are like. IMO, you'd be foolish to sign up for a career without knowing what to expect.

I also find the sanctimonious responses on SDN in particular to be odd, because all the surgeons I've interacted with on the wards are far more down-to-earth regarding work hour issues. For example, when I asked a CT surgeon about his work schedule once, he told me he'll take q2 call for the rest of his career, his operations are generally are longer than 4 hours a piece, and he frequently pushes 70hr/wk on average, sometimes more sometimes less. He then welcomed me to shadow him and gave me his cell #, said if I can handle those hours he'd love to help me get into the field. He was very straightforward, and no nonsense guy, like most surgeons I've met in person.

We, as surgeons, as physicians, would love to spend 24x7 in the hospital for our sick patients who need it. We feel obligated to. It took the work hours restriction to keep us from doing that. We still stay late. We cover longer than we "should."

For those of you who see medicine as a job. As shift work. You fundamentally don't get it. We don't want you.

Again, the straw men and sanctimony seem to be a thing of the internet. I don't run into this when talking to residents/attendings.

 

[neusu]

See, this is the straw man that bothers me. You assume that students aren't willing to provide whatever care is necessary for their patents, just because they ask about what the hours are like. IMO, you'd be foolish to sign up for a career without knowing what to expect.

I also find the sanctimonious responses on SDN in particular to be odd, because all the surgeons I've interacted with on the wards are far more down-to-earth regarding work hour issues. For example, when I asked a CT surgeon about his work schedule once, he told me he'll take q2 call for the rest of his career, his operations are generally are longer than 4 hours a piece, and he frequently pushes 70hr/wk on average, sometimes more sometimes less. He then welcomed me to shadow him and gave me his cell #, said if I can handle those hours he'd love to help me get into the field. He was very straightforward, and no nonsense guy, like most surgeons I've met in person.



Again, the straw men and sanctimony seem to be a thing of the internet. I don't run into this when talking to residents/attendings.

I'm not sure what you mean by straw man, can you clarify?

I'm happy working the hours I work. They are long and hard. I love my patients. I love when they get better, I hurt when they hurt. I'd be happy to help you to get in to my field.

What I am saying, is that, unless my field is an anomaly, all of medicine is this way. We, as doctors, truly care for our patients. We don't have a union. We don't work shifts. We care. Perhaps, in the modern sense of medicine, our caring has become placing orders and checking vitals, less personal contact. Nonetheless, I find myself checking in on my patients remotely on my days off, or when I get home. Not because I have to, or for any legal obligation, but because I honestly care about these people.

 

[KinasePro]

I'm not sure what you mean by straw man, can you clarify?

I'm happy working the hours I work. They are long and hard. I love my patients. I love when they get better, I hurt when they hurt. I'd be happy to help you to get in to my field.

What I am saying, is that, unless my field is an anomaly, all of medicine is this way. We, as doctors, truly care for our patients. We don't have a union. We don't work shifts. We care. Perhaps, in the modern sense of medicine, our caring has become placing orders and checking vitals, less personal contact. Nonetheless, I find myself checking in on my patients remotely on my days off, or when I get home. Not because I have to, or for any legal obligation, but because I honestly care about these people.

A straw man is when you mischaracterize someone's else's point of view and offer a treatise against the mischaracterized point of view that they never held in the first place. More on that here: http://en.wikipedia.org/wiki/Straw_man.

In this case, you're basically making a straw man of anyone asking about work hours. You say they're shift workers who don't feel obligated to go the extra mile for their patients, wouldn't stay beyond 80 hrs to care for their patients, and are "fundamentally different" from good surgeons and therefore don't belong in your field. How do you know they don't share your exact patient care philosophy, and just simply want to know what the hours will be like should they choose XYZ surgical field?

 

[ram006]

Point. Set. Match.

 

[neusu]

A straw man is when you mischaracterize someone's else's point of view and offer a treatise against the mischaracterized point of view that they never held in the first place. More on that here: http://en.wikipedia.org/wiki/Straw_man.

In this case, you're basically making a straw man of anyone asking about work hours. You say they're shift workers who don't feel obligated to go the extra mile for their patients, wouldn't stay beyond 80 hrs to care for their patients, and are "fundamentally different" from good surgeons and therefore don't belong in your field. How do you know they don't share your exact patient care philosophy, and just simply want to know what the hours will be like should they choose XYZ surgical field?

Interesting. I am not saying they don't share our beliefs. What I am saying, is most people who inquire about our hours do not share our beliefs. Personally, I never questioned how many hours a week a neurosurgeon worked. All I knew is what they did, and I wanted to do that. Would this work if had had the preconceived notion, well I only want to work 60 hours a week at most. Likely not. I went in to this field, having heard stories of working 120+ hour weeks. Went in to the field, worked 120+ hour weeks. Am not disappointed. What I am disappointed by, for that matter, is people who want to marginalize medical care because of their own personal interests.

 

[ram006]

"What I am disappointed by, for that matter, is people who want to marginalize medical care because of their own personal interests."

You did it again.

 

[dbeast]

A dermatologist provides equivalent care for his/her patient's skin as a neurosurgeon does for his/her patient's brain. Just because you work harder doesn't make you an inherently better doctor.

 

[mercaptovizadeh]

Interesting. I am not saying they don't share our beliefs. What I am saying, is most people who inquire about our hours do not share our beliefs. Personally, I never questioned how many hours a week a neurosurgeon worked. All I knew is what they did, and I wanted to do that. Would this work if had had the preconceived notion, well I only want to work 60 hours a week at most. Likely not. I went in to this field, having heard stories of working 120+ hour weeks. Went in to the field, worked 120+ hour weeks. Am not disappointed. What I am disappointed by, for that matter, is people who want to marginalize medical care because of their own personal interests.

What beliefs, exactly? That you are indispensable?

Care is only marginalized if you assume that you are the only (or best) person qualified to take care of the patients. There is such a thing as delegation. There is also such a thing as distribution of labor across multiple individuals. This happens all the time, in companies, in laboratories, in governments, etc. The PI doesn't have to pipet every ELISA or even inspect the qRT-PCR results on a daily basis. He delegates the work to technicians and trainees and provides executive decisions, overarching directions, oversight.

Nobody said surgery could be a 40 hr workweek. Why it has to be a 120 hr workweek is beyond me. Are there no other highly qualified people who want to do neurosurgery who could take your 120 hr workweek and halve it to a 60 hr workweek? It's not about the hours. It's about a balanced life. Work is work, patients are patients, but there is actually more to life than this. You aren't God. You don't give life to your patients, and you (personally) are not essential. You are a cog in a machine called American healthcare and there will be plenty of highly qualified and dedicated people willing and able to take over your position if you suddenly became sick, incapacitated, or quit.

I worked for nearly 3 months with an American general (+thoracic) surgeon in a mission hospital in the Indian subcontinent. This man was amazing. He gave up recognition and prestige and money to serve others. He did general surgery, hepatobiliary, thoracic, lots of ortho, uro, ENT, ob/gyn, even plastic, etc. - basically didn't do elective neuro or ophtho. He practiced both internal medicine AND general surgery. He has literally played a role in saving dozens if not hundreds of lives which - in those destitute circumstances - would not continue were it not for his intervention. I am talking everything from tumors and trauma, burn victims and nec fasc, to bringing to term and delivering an abdominal ectopic pregnancy and managing all kinds of patients medically. He is NOT part of a cog in a healthcare machine and there is no one to replace him at that hospital in that village. He is on 24 hr/7 days/wk trauma call. Despite this, he does NOT work an 80 or 120 hr workweek. By my best estimate, he works a 60 hr workweek and he makes an amazing difference in the lives of his patients. He has a high quality of life, walking home to lunch and having a brief afternoon nap, then going back to the OR, and having dinner usually with his wife and four kids at 7-8 pm (sometimes he has to be in the OR then).

Please, get over your attitude.

 

[dbeast]

What beliefs, exactly? That you are indispensable?

Care is only marginalized if you assume that you are the only (or best) person qualified to take care of the patients. There is such a thing as delegation. There is also such a thing as distribution of labor across multiple individuals. This happens all the time, in companies, in laboratories, in governments, etc. The PI doesn't have to pipet every ELISA or even inspect the qRT-PCR results on a daily basis. He delegates the work to technicians and trainees and provides executive decisions, overarching directions, oversight.

Nobody said surgery could be a 40 hr workweek. Why it has to be a 120 hr workweek is beyond me. Are there no other highly qualified people who want to do neurosurgery who could take your 120 hr workweek and halve it to a 60 hr workweek? It's not about the hours. It's about a balanced life. Work is work, patients are patients, but there is actually more to life than this. You aren't God. You don't give life to your patients, and you (personally) are not essential. You are a cog in a machine called American healthcare and there will be plenty of highly qualified and dedicated people willing and able to take over your position if you suddenly became sick, incapacitated, or quit.

I worked for nearly 3 months with an American general (+thoracic) surgeon in a mission hospital in the Indian subcontinent. This man was amazing. He gave up recognition and prestige and money to serve others. He did general surgery, hepatobiliary, thoracic, lots of ortho, uro, ENT, ob/gyn, even plastic, etc. - basically didn't do elective neuro or ophtho. He practiced both internal medicine AND general surgery. He has literally played a role in saving dozens if not hundreds of lives which - in those destitute circumstances - would not continue were it not for his intervention. I am talking everything from tumors and trauma, burn victims and nec fasc, to bringing to term and delivering an abdominal ectopic pregnancy and managing all kinds of patients medically. He is NOT part of a cog in a healthcare machine and there is no one to replace him at that hospital in that village. He is on 24 hr/7 days/wk trauma call. Despite this, he does NOT work an 80 or 120 hr workweek. By my best estimate, he works a 60 hr workweek and he makes an amazing difference in the lives of his patients. He has a high quality of life, walking home to lunch and having a brief afternoon nap, then going back to the OR, and having dinner usually with his wife and four kids at 7-8 pm (sometimes he has to be in the OR then).

Please, get over your attitude.

I totally agree, and this part of what bums me out about general surgery. One can make the argument that every surgeon who primarily does appy's and chole's is easily replaceable. That's why I was asking earlier in this thread about doing a community gen surg program, so I could develop strong relationships with patients and families in the absence of a unique and essential practice. I just love operating, but haven't found a surgical subspecialty that has really snatched up my interest, and I'm okay with that.

To all the guys glorifying their work schedule, sorry to inform you that we (including myself) are not special snowflakes. The competitiveness of surgical residencies and the filling of available positions supports this idea that if you don't apply, somebody else will. Here's the moral of the story- as doctors of all specialties, we simply do our best to make strangers feel better, and there's no purpose in idealizing one specialty above another in order to rationalize a very hefty time commitment. Call me crazy, but I think some humility is a good characteristic in a future surgeon, and I hope I carry it into my practice if I do in fact choose surgery. Although, this discussion seems to be split in whether my attitude will fit well other surgeons. Carry on, people, this is fun.

Also, props on that abdominal ectopic. Wtf.

 

[punkedoutriffs]

This whole discussion reminds me of Kazuo Ishiguro's "Remains of the Day." Has anyone else read it or watched the movie w/ Anthony Hopkins & Emma Thompson?

SPOILERS!!!!!! (If anyone cares) It's about a butler whose fanatical devotion to the idea of embodying the perfect dignified professional led him to put on blinders to all other aspects of life. As a consequence, he did not adequately attend to his father's death. He missed out on the love of his life. In addition, it turned out that Lord Darlington, his employer, was a Nazi sympathizer. The realization of all this leads to a profoundly heartbreaking disillusionment at the end. He's old now and every happiness had passed him by. The only thing he has left at the end is "work, work, and more work."

Every time someone says, "You don't get it," I want to respond, "Maybe so, but have you considered that there are things that you don't 'get' either?"

 

[ram006]

Pretty sure if Neusur's PD saw him getting worked over by a bunch of med students he'd have to at least repeat a year.

 

[ortho11111]

The surgical specialties are all a little different too. For instance, orthopedic residents work their tails off on trauma rotations and on call, but tend to calm down on their peds, sports and hand rotations. In ortho, call schedules vary from Q3 in some programs to Q14 with night float. I'm not convinced the Q14 programs produce worse orthopedic surgeons than the old Q3-4 programs.

 

[KnuxNole]

This post, my friends, encapsulates why millennial medical students are storming in droves towards the ROAD specialties and those specialties not in the mnemonic with a better lifestyle. Keep in mind that neusu is a neurosurgery resident, but this mentality and work ethic is present in most surgical attendings, esp. in academic medical centers.

There are some specialties in general surgery that are much better in lifestyle with great compensation but just remember that everyone else in your general surgery residency class is gunning for those specialties as well, and thus there is a sizable and real chance that you may be "stuck" doing general surgery for the rest of your life.

To the OP, the attrition rate of general surgery is 20%, even with work hour restrictions and it's not likely due to the hours:
http://skepticalscalpel.blogspot.com/2012/06/why-is-attrition-rate-of-general.html
http://www.ncbi.nlm.nih.gov/pubmed/20739854

I agree, I see medicine as a job, not something I'd attach to the hip 24/7. We are doctors, normal people, and have lives too! Then again, that is why I would never think about NS. After all, family, friends and hobbies are nice to spend time with, plus I'm a fan of sleeeeeep

I would be drained of the people who live, breathe, and sleep medicine every waking hour too. As someone who hates talking about medicine during down time/free time, I'd be subjected to someone constantly wanting to talk about patients, where I'd simply want to talk about the game last night or what we did over the weekend.

 

[KnuxNole]

I'm not sure what you mean by straw man, can you clarify?

I'm happy working the hours I work. They are long and hard. I love my patients. I love when they get better, I hurt when they hurt. I'd be happy to help you to get in to my field.

What I am saying, is that, unless my field is an anomaly, all of medicine is this way. We, as doctors, truly care for our patients. We don't have a union. We don't work shifts. We care. Perhaps, in the modern sense of medicine, our caring has become placing orders and checking vitals, less personal contact. Nonetheless, I find myself checking in on my patients remotely on my days off, or when I get home. Not because I have to, or for any legal obligation, but because I honestly care about these people.

EM works shifts

I don't fault you at all, keep doing what you are doing, after all, a doc who's loved by his patients and is doing a good job should keep at it. However, there are plenty of fields where once you are home, you separate yourself from work completely. Or residents who hate staying later than 5pm;constantly dumping on the call person. I'm sure even NS has people guilty of this :O

 

[DermViser]

The surgical specialties are all a little different too. For instance, orthopedic residents work their tails off on trauma rotations and on call, but tend to calm down on their peds, sports and hand rotations. In ortho, call schedules vary from Q3 in some programs to Q14 with night float. I'm not convinced the Q14 programs produce worse orthopedic surgeons than the old Q3-4 programs.

I'm sure there are some surgery PDs out there, that will put out a paper with questionable statistics and get it published in Annals of Surgery, that having Q14 is worse for patients (will someone think of the patients?!) than Q3, which will then be parroted by every surgery PD to justify their insane, malignant hours of residents. Surgeons hate it when the status quo changes in any realm.

 

[DermViser]

I agree, I see medicine as a job, not something I'd attach to the hip 24/7. We are doctors, normal people, and have lives too! Then again, that is why I would never think about NS. After all, family, friends and hobbies are nice to spend time with, plus I'm a fan of sleeeeeep

I would be drained of the people who live, breathe, and sleep medicine every waking hour too. As someone who hates talking about medicine during down time/free time, I'd be subjected to someone constantly wanting to talk about patients, where I'd simply want to talk about the game last night or what we did over the weekend.

I notice that the ones that are live, breath, and sleep medicine tend to be the most irritating to their fellow residents, rightfully or wrongfully get the label of "weird", and also the ones who burn out the quickest.

 

[DermViser]

Or they'll do this:

https://surgapps.fsm.northwestern.edu/TheFirstTrial/Overview/Overview

If you think that such a "clinical" trial won't be gamed by PDs and Hospitals with such "hard" metrics as patient care, surgical outcomes, and resident perceptions, then you're highly mistaken.
The study is for 2 years, and a general surgery residency is 5 years long. The way this study is designed no where proves that a ridiculous amount of hours makes you a better doctor. There are quite a few ridiculously long hour surgery residencies in which their own residents have a high ABSITE failure rates, and I refuse to believe that it's due to them just being stupid.

I noticed this in the study --
Allowed to eliminate all resident duty hour rules with the following exceptions:
◦Duty hours limited to 80 hours/week averaged over 4 weeks.
◦Minimum of one free day (no duty)/week averaged over 4 weeks.
◦May not take in-house call more frequently than every 3rd night, averaged over 4 weeks.

If they can't eliminate the 80 hr. work week in the intervention arm, then what's the use of having this study? That's the whole argument that attendings make that somehow they are better doctors (compared to residents now) bc their work hours were longer. If they actually cared, they would compare 2 groups: one group with no work hour restrictions and one group with work hour restrictions.

 

[ram006]

This study implies accurate logging of duty hours which is known to be pretty atrocious.

I agree a lot of this is driven by attendings perceiving themselves as better than current residents because of more experience. It's very unlikely every attending/chief resident out there was a stellar intern or junior resident.

Moreover, I don't spend 120 hours a week in the hospital because I have an iPhone and remote access to imaging... this is the 21st century after all.

 

[ram006]

Sort of.

Duty hour accuracy does have the potential to be "bad" in either arm. And reliance on self-reported data is always a limitation.

But the elimination of the 16 hr requirement is a big difference - that allows a total structural overhaul (i.e. interns can take traditional 24 hour calls) that are currently not possible. So it is more or less comparing traditional call to night float.

That's interesting. I'd like to know the answer to that. Having now done both, I think night float is much worse than taking q 3 24 hr call.

You can't fudge away at a program level whether your interns are working 24 hr or 12/16 hr shifts.

Right. That's a good point, but you also can't account for residents getting pulled into a liver transplant after a 24 hour call and subsequently pretending like it never happened when they log their hours. That was a personal anecdote, but it's also not an isolated event. Yet, I've always come out as compliant with duty hours. There are just some rotations trauma (cough) that will never fit the 80 hour work week.

I would imagine the control group is going to feel pressure to log 80 hours regardless of whether or not they're actually compliant. Mostly to avoid an email from the PD asking why you're so inefficient and being labeled as a problem child. Probably not at all programs, but most likely at major academic, trauma heavy places.

Overall, I think the 80 hour restrictions are good if for no other reason than if residents feel abused, as a whole, they have a way to speak up. If people are happy, no one wants to be the reason their program loses ACGME accreditation.

 

[DermViser]

They are essentially comparing the 2003 duty hours to the 2011 duty hours. I think just about everyone agrees that the overall 80 hr limit is here to stay, and is by and large a very good thing.

Given that all of the patient metrics involved will be NSQIP, I highly doubt PDs will be able to "game" the results.

Edit: To clarify and state my thoughts a little more strongly.

This is a prospective, randomized, multi center trial comparing the previous and current duty hour requirements, powered to detect differences in patient outcomes using a well-validated and rigorous clinical data registry, with secondary outcome measures of resident satisfaction and academic performance.

It is the first prospective study of duty hour requirements, in any field, since the institution of duty hour regulations in 2003.

Karl Billimora is a smart dude. It's a very robust study design. And awesome that the ACGME is onboard with something like this.

If they are actually serious about this - they should install swipe card machines where you swipe your id when you clock in, and when you clock out so that work hours are electronically tabulated. None of this self-reported B.S. by residents, as it is quite clear how well the system is gamed by residencies, as evidenced by the Serrano case against Johns Hopkins Surgery. If this clinical trials study will be one which affects educational policy - then the numbers need to be darn accurate - meaning no self-reporting, just a swipe in and swipe out, and a computer tabulates.

The only difference between the 2003 and 2011 regulations are the elimination of 24 hrs. continuous as a PGY-1 (so now it's 16 hrs. continuous as a PGY-1). Big whoop - 8 hrs.
https://www.acgme.org/acgmeweb/Portals/0/PDFs/dh-ComparisonTable2003v2011.pdf

Attending surgeons have been bitching since 2003 about how they are so much better doctors when they graduated from residency (from a knowledge base standpoint as well as managing patients) than graduates coming out of residencies now due to there being work hour restrictions in the first place. This new clinical trial only compares one set of work hour restrictions to another. So even if it was shown that those under the 2011 guidelines did better than those under the 2003 guidelines, that just proves that one set of work hour restrictions are better than another. The real and ultimate debate has been whether you are in fact a "better" doctor from graduating from a residency with work hr. restrictions vs. graduating from a residency without work hr. restrictions. Anything less is a waste of time.

 

[DermViser]

I disagree with your fundamental premise, so I suspect any discussion about this is going to be fruitless. Nonetheless...

This is a rather hilarious brush off of the magnitude of changes brought about by the 2011 regulations. Anyone who was in a residency (or involved in) one at the time of the change can tell you exactly how big a deal these new regulations are. They essentially killed the traditional overnight call which was how 90+% of surgery residencies took care of patients. I'm not saying that I think the new hours or better or worse, but these new regulations have been a huge deal for programs.

Are you seriously going to disagree that surgery attendings who underwent residency without work hour restrictions (many of whom become program directors and medical school faculty), don't make the argument that they are better surgeons than those who did undergo residency with work hours restrictions?

Surgery residents also can take 24 hour call in PGY-2, 3, 4, and 5 as well.

 

[joanofarc0907]

Two comments:
1. When you really think about how long residency is comparing surgery residency to IM.
-GS residency 5 years, Vascular Integrated 5 years, Plastics 6 years, ENT 5 years, most fellowships in surgery 1-2 years. Neurosurg is an exception in length from these, but overall you can expect to be "finished" by 5-7 years
-IM residency (or peds) 3 years. Most fellowships 2-3 years. Grand total 6 years.

So medical students, pick what you like since, as you can see above, the total number of years aren't very different unless you don't do a specialty within IM or Peds

2. In terms of the duty hour talk above
- ACGME rules exclude home call in the 80 hour equation. It is very real possibility that you can be completely compliant with 80 hour work week and are on home call (answering pages, not sleeping, etc) for another 20-40 hours/week depending on your residency's use of home call. So in practicality, you still feel like you're working 105 or 120 hours that week even if some of them were spend answering pages from your couch instead of the resident lounge at the hospital. That being said, home call varies in intensity and on light days it sure is nice to be home instead of in the hospital!
(Of note, time back physically in the hospital on home call does count toward 80 hours though).

 

[Coffee Machine]

And I am fully aware of all the duty hour changes. I live them. But if PGY 2,3,4,5 residents are taking the 24 hr calls that interns used to, it means that (a) interns aren't learning to take care of patients and (b) senior residents aren't getting the operative experience they need. Few programs are willing to shift intern call duties uphill onto senior residents. And if they are requiring that, well that is an even bigger paradigm shift as a result of the 2011 duty hour changes.

As a medical student, I don't really know much of anything about anything, but this sounds really crappy to me. What do you think the odds are that they do away with the 16hr intern call rule in the next few years?

 

[vhawk]

lol. Participation trophies for everyone!

 

[vhawk]

Pretty sure if Neusur's PD saw him getting worked over by a bunch of med students he'd have to at least repeat a year.

Sad for you if thats what you think is happening. Despite what your GME office has brainwashed you to believe, your duty to your patients and your obligation to log your work hours according to policy do not miraculously align

 

[vhawk]

I agree, I see medicine as a job, not something I'd attach to the hip 24/7.

And in a perfect world, you wouldnt be able to match into any kind of serious residency spot. Fortunately for you, you are a "millenial" and there are plenty of spots for you.

Medicine isnt just a job, you take care of sick people, you make critical decisions, and for some people that is a sacred duty and obligation. It isnt punching a clock, and it isnt being preoccupied with bureaucratic compliance.

 

[vhawk]

I'm sure there are some surgery PDs out there, that will put out a paper with questionable statistics and get it published in Annals of Surgery, that having Q14 is worse for patients (will someone think of the patients?!) than Q3, which will then be parroted by every surgery PD to justify their insane, malignant hours of residents. Surgeons hate it when the status quo changes in any realm.

It doesnt even make a ripple in your worldview that all of the changes in supervision and work hours have had absolutely zero positive impact on patient outcomes, eh? What WOULD it take to convince you you were (self-servingly) wrong?

 

[vhawk]

Two comments:
1. When you really think about how long residency is comparing surgery residency to IM.
-GS residency 5 years, Vascular Integrated 5 years, Plastics 6 years, ENT 5 years, most fellowships in surgery 1-2 years. Neurosurg is an exception in length from these, but overall you can expect to be "finished" by 5-7 years
-IM residency (or peds) 3 years. Most fellowships 2-3 years. Grand total 6 years.

So medical students, pick what you like since, as you can see above, the total number of years aren't very different unless you don't do a specialty within IM or Peds

2. In terms of the duty hour talk above
- ACGME rules exclude home call in the 80 hour equation. It is very real possibility that you can be completely compliant with 80 hour work week and are on home call (answering pages, not sleeping, etc) for another 20-40 hours/week depending on your residency's use of home call. So in practicality, you still feel like you're working 105 or 120 hours that week even if some of them were spend answering pages from your couch instead of the resident lounge at the hospital. That being said, home call varies in intensity and on light days it sure is nice to be home instead of in the hospital!
(Of note, time back physically in the hospital on home call does count toward 80 hours though).

I'm sorry, are you seriously suggesting that on average, a MS4 who matches into an IM spot is going to spend the same number of years in training as an MS4 who matches into a surgical spot? And your argument is that those IM people who spend the maximum possible time are about equivalent to surgeons who spend the minimal time? SDN is hilarious

 

[vhawk]

As a medical student, I don't really know much of anything about anything, but this sounds really crappy to me. What do you think the odds are that they do away with the 16hr intern call rule in the next few years?

I think it is a near certainty. There is currently in the works a large national randomly controlled study where about half the programs in the country will continue to abide by the current rules and the other half will be randomized into a group in which they can do whatever they want with their interns (within reason). The results of this study are basically a lock to be equivalent (at the least, if not better outcomes for the flexible group) which should pretty convincingly show that, for surgery programs at least, the new restrictions do not in any way benefit patients and in a very real way hurt residents.

 

[DermViser]

It doesnt even make a ripple in your worldview that all of the changes in supervision and work hours have had absolutely zero positive impact on patient outcomes, eh? What WOULD it take to convince you you were (self-servingly) wrong?

The issue is NOT whether there is a "positive impact" on patient outcomes, but whether there has been a negative impact on patient outcomes, due to the changes in work hours, at least not written by those who have a direct conflict of interest (i.e. residency program directors).

Working surgical residents to the point of pure exhaustion, that most couldn't comprehend, is not conducive to learning nor their training. You can deny all the research regarding the detrimental effects. This is hazing, for hazing's sake. It's probably one of the main reasons, if not the reason, that general surgery has lost people at the top of the medical school class to other specialties.

 

[vhawk]

The issue is NOT whether there is a "positive impact" on patient outcomes, but whether there has been a negative impact on patient outcomes, due to the changes in work hours, at least not written by those who have a direct conflict of interest (i.e. residency program directors).

Working surgical residents to the point of pure exhaustion, that most couldn't comprehend, is not conducive to learning nor their training. You can deny all the research regarding the detrimental effects. This is hazing, for hazing's sake. It's probably one of the main reasons, if not the reason, that general surgery has lost people at the top of the medical school class to other specialties.

What are you talking about? When all of the work hour restrictions were implemented, the pretext was always that these poor, overworked residents were hurting patients. Do you know who Libby Zion is?

So you want me to believe that we should change work hours to protect the poor overworked residents, EVEN IF it is shown that it does not benefit patients in any way? So the end goal is purely to make life better for trainees?

 

[KnuxNole]

And in a perfect world, you wouldnt be able to match into any kind of serious residency spot. Fortunately for you, you are a "millenial" and there are plenty of spots for you.

Medicine isnt just a job, you take care of sick people, you make critical decisions, and for some people that is a sacred duty and obligation. It isnt punching a clock, and it isnt being preoccupied with bureaucratic compliance.

Yay for millenials! Woot!

Of course we take care of sick people. And it is a nice duty(giggle....duty). Of course, you agree that it is NEVER a 24/7 job, and you and I both have lives outside of medicine. It IS a job, not a life. I don't define myself by medicine. You and I both know there are tons of specialties where they punch the clock and they find no problem with it.

 

[vhawk]

I'm about the last person to support any policy simply because thats how they did it "in the good old days." I think most old surgeons are delusional and suffering from a huge case of "walked uphill in the snow both ways"-itis. That being said, I've also gone through a surgical residency program in the era of 80 hour restriction, as well as the more recent more stringent restrictions, and I am well aware of their specific limitations. They are targeted to eliminate the judgment and discretion of surgical residents. This is abhorrent to me. We are training people to be in a position to exercise judgment that literally means life or death to vulnerable patients who cannot decide for themselves, and yet we are so terrified of these same people's judgment that we force them to go home at exactly 16 hours and force them to get at least 10 hours between shifts every day. Its inconsistent and illogical.

 

[vhawk]

Yay for millenials! Woot!

Of course we take care of sick people. And it is a nice duty(giggle....duty). Of course, you agree that it is NEVER a 24/7 job, and you and I both have lives outside of medicine. It IS a job, not a life. I don't define myself by medicine.

No. But you seem like a pretty honest, upstanding guy. So I'm absolutely CERTAIN that you put similar sentiments into your personal statement, right?