Duty Hour Standards

[SocialistMD]

The ACGME has posted its new proposed standards to take effect July 2011.

Overview:

• Limited to 80 hours/week
• PGY-1 residents limited to 16 hours/day
• PGY-2 + residents limited to 24 hours/day + 4 to tidy up
• Nap time "strongly suggested" but not required
• No more than 6 consecutive nights of night float
• PGY-2+ call no more frequent than Q3 (No averaging)

---

Members don't see this ad.

 

[JackADeli]

The ACGME has posted its new proposed standards to take effect July 2011.



Overview:

• Limited to 80 hours/week
• PGY-1 residents limited to 16 hours/day
• PGY-2 + residents limited to 24 hours/day + 4 to tidy up
• Nap time "strongly suggested" but not required
• No more than 6 consecutive nights of night float
• PGY-2+ call no more frequent than Q3 (No averaging)

It's possible.... but you'll need the old guard to get out of the way. This will include the senior residents that have been waiting to get their returns on the backs of new incoming juniors.
The PGY1 16hr day will be a tough one. They sure as hell better start acing the ABSITE!!!

 

[Buzz Me]

Does that mean the new interns won't be able to take in-house call?!

And does the Q3 call rule for PGY-2+ include home call?

 

[Miyagi]

I am SO glad I am not a chief resident anymore!!
This is ludicrous....who is going to take in-house call on the weekends? PGY-2 thru PGY-5?
"oh..sorry Dr.Intern, it's 10pm on friday night..time for you to go home so you can go beddy nighty-night so the sr/chief can do your work. See you monday".....WTF!

 

[TheGrog]

Page 17 starts the new rules.

The way I read them are that:
1. Interns will no longer have overnight call.......ever. WT*? Enough said.

2. PGY-2 and above need minimum of 14 hours free after call. I wish(ed)

3. PGY-1 residents "should have 10 hours, and must have eight hours, free of duty between scheduled duty periods". 8 or 10, so what is it?

4. "Residents in the final years of education should have 10 hours free of duty, and must have eight hours between scheduled duty periods. However, these residents must be prepared to enter the unsupervised practice of medicine and care for patients over irregular or extended periods." So how the **** are they to be prepared when they have nonstop consults coming in at hour 25?!?!?! Or when they have only been home for 5 hours?

5. " PGY-2 residents and above must be scheduled for in-house call no more frequently than every-third-night (no averaging)." Again, Interns no longer take call.

I am so glad to be out of this game now. I don't know what the ACGME was smoking when they came up wiht this.....but I want some!!!!

 

[JackADeli]

I haven't looked at the actual ACGME material on this and am only basing my replies on the information posted in this thread....

...who is going to take in-house call on the weekends? PGY-2 thru PGY-5?...

Nobody. The ~disparity will maneuver senior residents PGY4/5 into advocating the plan they are not stating.

It would seem they have all but removed PGY1 from the call rotation. Based on that, my read is that without coming out and saying it, ACGME is outlawing/banning overnight call and imposing all programs go to a night float system. That would be the only way to utilize the resident power and still be in compliance. They are avoiding actually coming out and saying it but "nudging" programs into it with a structured and calculated set of rules and guidelines.

I have seen posted here stuff about call and hours. To top this cake, what does it say about day/s off per week/month?

 

[dpmd]

This is crap. Why do they feel interns shouldn't take call?

Hmm, since my program only has two residents per year it means that second years and third years are going to have to take call, or we are going to have to make the interns do some crazy schedule gymnastics (maybe make the off service folks cover all the nights).

 

[JackADeli]

...Why do they feel interns shouldn't take call?...

I don't think they actually believe/feel that way. My impression is that this is a rather deceptive and fairly clever means of overcoming the biggest problem faced by ACGME in trying to get compliance.

To confirm compliance with current structures, you depend on honest disclosure by residents. This is fundamentally flawed as has been demonstrated and/or debated on these forums for years. Some residents feel threatened/pressured to lie to ACGME site visitors. Others want to prove their metal and lie on their time sheets and lie to the site reviewer. It is clear attendings have failed to buy in and have contributed to this facade of compliance.

So, ACGME apparently comes up with the scheme reported above by OP. They effectively remove 1/5 of the residents from the call schedule. They eliminate "average" from the allowable number of calls. They cut down on the post call number of hours. This structure all but forces you into a night float system. Yes, residents will probably lie and work 18 instead of 16 hours. but, still, by eliminating 24+ hour periods, total number of hours will drop probably to 70 or less.

Further, residents can lie about small chunks of hours. However, site reviewer can look at entire compliment of residents and call schedule and now call foul on what is reported and what is real based mostly on numbers without resident disclosure.

Will this plan work? I don't know. The plan comes into existance like everything else in medicine as a result of physicians' lack of proactive initiative and accountability. Attendings lie and residents lie. ACGME is serious and has been pushing.

 

[JackADeli]

The ACGME has posted its new proposed standards to take effect July 2011...

curious why it says July 2007 at the bottom. Maybe this is some sort of draft idea that was chopped?

So, I read the letter/site posting, it is a draft being offered up for further commentary. I am not sure if this will be the final version.

 

[DRshooter]

Could surgery programs band together and leave the ACGME?
It seems to me they have no idea what it takes to train a surgeon.
Why is it that they are so hellbent on messing with a system that has consistently created the best surgeons in the world?

 

[JackADeli]

Could surgery programs band together and leave the ACGME?
It seems to me they have no idea what it takes to train a surgeon.
Why is it that they are so hellbent on messing with a system that has consistently created the best surgeons in the world?

There are numerous residencies within ACGME. This is not about messing with surgery. It may actually do that... but not IMHO the intent. Surgeons of quality may be successfully generated through our current system but that is not necessarily a ringing endorsement of the quality of our programs. I get the sense this is about trying to modernize education & training and overcome the "old school" holdouts.

 

[ESU_MD]

It is a shame that the whole duty hour thing couldnt be handled directly within the surgery RRC. Not all residents need to be trained in the same fashion.

Although, I'm not sure that accountability can ever really be taught to anyone. either you get it... or you dont.

 

[45408]

Could surgery programs band together and leave the ACGME?
It seems to me they have no idea what it takes to train a surgeon.
Why is it that they are so hellbent on messing with a system that has consistently created the best surgeons in the world?

Yes, apparently they can leave the ACGME, and there are certainly people thinking about it.

 

[JackADeli]

It is a shame that the whole duty hour thing couldnt be handled directly within the surgery RRC. Not all residents need to be trained in the same fashion.

Although, I'm not sure that accountability can ever really be taught to anyone. either you get it... or you dont.

The problem is that surgery has failed to come to the table in good faith and honesty. Surgery whined and cried (as did IM & OB/Gyn) about the initial 80hr requirements. They were dragged kicking and screaming to it. "it will never work....we can't train residents under these restrictions....", etc, etc... But, after the mandate came down, the vast majority of programs claimed to be well within compliance and provided evidence to show their compiance. Numerous programs with night float brought to the site visitors "evidence" of well under 80hrs/wk, sometimes under 60hrs/wk. Numerous residents have graduated under the current rules AND received board certification.

To top it, the ACGME allowed for individual program waivers/extension of hours through an application process. Again, very, very few programs applied. The message was clear and the extensions were not renewed and the ACGME came out with a statement that no other extensions would be granted. What did the extension application require? It required the program/PD to apply and document the educational need. If you have hundreds of programs around the country demonstrating compliance and only a handful saying they require more hours, I think the message to the ACGME was the handful needed better leadership and more efficient program structure.

Long and short, it is apparent residents and attendings have lied on all sides from the start. They lied when they declared they couldn't train residents under these guidelines. They have lied about actual implementation. And, they have almost as a whole, failed to provide any written documentation/proof as to why, from an educational standppoint they need 80+hours per week and/or greater on-call experience to train a competent specialist (i.e. IM, Ob/Gyn, surgery, etc...). On the contrary, surgery programs have bent over backwards through their ~"compliance" to prove the ACGME correct in its analysis. Again, look at the night float programs and what kind of weekly hours they are recording.

 

[smq123]

It would seem they have all but removed PGY1 from the call rotation. Based on that, my read is that without coming out and saying it, ACGME is outlawing/banning overnight call and imposing all programs go to a night float system.

Well, either you would go to a completely night float system (including weekends, which means that you'd need 4 "shifts" to cover Friday night to Sunday afternoon), or you make the interns take "home call," but make them come in for every central line, every ABG, every consult, every admission, every emergent case.

In other words, you could turn every intern "call" into the "long call" system that IM uses, and then put them on home call for the rest of the night. Home calls don't count as shifts (since no one knows if you'll get called in), so you're technically not violating the rules. This would be the stupidest system, ever, but it *could* work. Sort of.

I have seen posted here stuff about call and hours. To top this cake, what does it say about day/s off per week/month?

No change. Still 1 in 7, averaged over 4 weeks.

 

[glade]

I hate to shatter anyone's world view, but these rules don't affect anything. When it says that interns don't work more than 16 hours/day, that's PER DAY. The day ends at midnight. You can work sixteen hours one day and then continue from midnight on during call, not to exceed 80 hours/week or 24 + 4 hours consecutively.

Besides, who really gives a crap at the end of the day? I care much more about declining reimbursements and having to take care of idiotic patients than whether an intern two years from now has to take call.

 

[SLUser11]

I hate to shatter anyone's world view, but these rules don't affect anything. When it says that interns don't work more than 16 hours/day, that's PER DAY. The day ends at midnight. You can work sixteen hours one day and then continue from midnight on during call, not to exceed 80 hours/week or 24 + 4 hours consecutively.

It doesn't say "per day," it says 16 hour "duty period." I'm pretty sure that applies to overnight call. Otherwise, I'm not sure how a restriction limiting PGY-2s to a "24 hour duty period" would be necessary. Semantics...

 

[glade]

I'm just reading what was posted in the original post. Like I said, I neither know nor care what the guidelines are. Especially since the brutal fact is that neither do any of your residency programs. If you think that interns aren't taking call, you guys are even bigger suckers than I thought.

 

[GreatSaphenous]

I hate to shatter anyone's world view, but these rules don't affect anything. When it says that interns don't work more than 16 hours/day, that's PER DAY. The day ends at midnight. You can work sixteen hours one day and then continue from midnight on during call, not to exceed 80 hours/week or 24 + 4 hours consecutively.

Besides, who really gives a crap at the end of the day? I care much more about declining reimbursements and having to take care of idiotic patients than whether an intern two years from now has to take call.

I am not feeling particularly snarky, so I'll just say that I beleive that is 16 hours per shift.
i.e. "Duty periods of PGY-1 residents must not exceed 16 hours in duration."

Point taken about finding other things to care about though. I am just glad that I have graduated; now off to do some "strategic napping."

All for now, go back to your patty melts,
I am the Great Saphenous!!!!!

 

[dpmd]

I'm going to guess that they will count a day as the beginning of your in house obligations, to the end of them. Otherwise you would be able to get around the 30 hr rule by saying "hey those hours I worked before midnight suddenly don't count"

 

[glade]

If it's "per shift," then the ACGME needs to get better lawyers. Ones who can write. Because it's reported as "per day."

 

[glade]

When it says "nap time is strongly suggested," I take that to mean that they are encouraging junior residents to participate in more laparoscopic cases. Nothing like being in a case where the lights are off, you're not doing anything, and the medical student is driving the camera. The only problem is when you'd fall face first into the patient and knock the instruments around and everyone would get all angry for some reason. You'd be like "where am I again?"

 

[GreatSaphenous]

"Duty periods of PGY-1 residents must not exceed 16 hours in
duration."

Let's leave lawyers out of this

 

[glade]

If that's what the PDF says, then I agree that it makes no sense. After all, why limit PGY-1 and -2 duty hours and say nothing about the -3 to -5s? By implication, doesn't that mean that a -3 could be hanging out at the hospital all day, banging nurses and participating in other educational activities?

 

[ESU_MD]

I dont think you need to have interns living in the hospital these days, but comeon... enough is enough with babying down the surgical training program. does anyone really adovcate no call for interns???
a few hard nite calls never hurt anyone. what is wrong with an intern coming in at 5am on Fri and learning/working til noon on Saturday? We all did it and survived.

i'm sure theres no 80-hr limit to the navy seals hell week. we arent training to be cub scouts.

i agree that the nite float system is pretty nice and has revolutionized the call schedule, but it just cant be applied to every service and encompass every resident.
I am afraid if we put TOO MUCH emphasis on shift work, then we will be no better than an er doctor training program.... sign out to the next shift worker.

being a surgeon means doing the right thing no matter how tired you are. sometimes that means getting a colleague to help you admit a patient or follow up an xray, sometimes that means sucking it up and doing it yourself. Emphasis on shift work has a risk of letting new trainees think its ok to blow things off once the 12hr whistle blows and they punch out on the time clock.

the concept of resident work hour restrictions is nice, and has probably not had a big negative impact, but we risk the pendulum swinging too far to the point where resident education IS compromised.

maybe

 

[glade]

i) Nobody is learning a damn thing on call, contrary to popular belief. In fact, 99% of people get more stupid the longer call progresses.

ii) Could people stop comparing residency to being in the Navy Seals? There's a reason they do what they do. If you told me residency was preparing me to be an elite fighting unit and my mission was to unleash total destruction on someone from behind enemy lines when called to duty, then I'd understand. Otherwise, we're being just a tad melodramatic.

 

[DRshooter]

i) Nobody is learning a damn thing on call, contrary to popular belief.

ii) Could people stop comparing residency to being in the Navy Seals? There's a reason they do what they do. If you told me residency was preparing me to be an elite fighting unit and my mission was to unleash total destruction on someone from behind enemy lines when called to duty, then I'd understand. Otherwise, we're being just a tad melodramatic.

1)You don't think you are learning anything on call???

2)Your patients would be well served if you thought of yourself as the "Navy seal" of the hospital....someone that gets the job done, period.

 

[glade]

Read my edited post and you'll know what I think of call.

I'm not saying that people shouldn't take call. I'm saying that let's not pretend call is something it's not. Call isn't "enlightening." It's like people act like you should be asking for more call so you can be more educated. Hey, you can take my share of education all you want. Have fun with that.

And your patients don't think of you or anyone else as a Navy Seal. They think of you as the hired help. I'd LIKE to be the Navy Seal, so I could bust the door open and start kicking ass, but that's sadly not what happens.

 

[Guile]

ii) Could people stop comparing residency to being in the Navy Seals? There's a reason they do what they do. If you told me residency was preparing me to be an elite fighting unit and my mission was to unleash total destruction on someone from behind enemy lines when called to duty, then I'd understand. Otherwise, we're being just a tad melodramatic.

I wish I knew you in real life.

 

[glade]

Nah, you'd probably be extremely disappointed. Like "that's you? WTF, good thing we have computers."

 

[SLUser11]

I dont think you need to have interns living in the hospital these days, but comeon... enough is enough with babying down the surgical training program. does anyone really adovcate no call for interns???
a few hard nite calls never hurt anyone. what is wrong with an intern coming in at 5am on Fri and learning/working til noon on Saturday? We all did it and survived.

i'm sure theres no 80-hr limit to the navy seals hell week. we arent training to be cub scouts.

i agree that the nite float system is pretty nice and has revolutionized the call schedule, but it just cant be applied to every service and encompass every resident.
I am afraid if we put TOO MUCH emphasis on shift work, then we will be no better than an er doctor training program.... sign out to the next shift worker.

being a surgeon means doing the right thing no matter how tired you are. sometimes that means getting a colleague to help you admit a patient or follow up an xray, sometimes that means sucking it up and doing it yourself. Emphasis on shift work has a risk of letting new trainees think its ok to blow things off once the 12hr whistle blows and they punch out on the time clock.

the concept of resident work hour restrictions is nice, and has probably not had a big negative impact, but we risk the pendulum swinging too far to the point where resident education IS compromised.

maybe

I don't necessarily disagree with you, but I think it's funny how much we are starting to sound like the old school attendings who complained about the 2003 duty hour regulations:

"We all did it and survived"
"sign out to the next shift worker"

I bet this goes through, and 10 years of surgeons are trained with it, then they cut down to the 56 hour work week, and all the newly minted docs will complain just like we are now.

 

[DRshooter]

Glade:

I could care less if the patient thinks of me as the help. I care about how I see myself and about how my interns see themselves. If you want to think that you are just "the help" and that gets you thru the day then thats fine. I rather my guys feel like they can hang and deal with the crap that gets thrown their way, that they feel some pride it their work and in the service they put in in the middle of the night.

 

[SouthernSurgeon]

I don't necessarily disagree with you, but I think it's funny how much we are starting to sound like the old school attendings who complained about the 2003 duty hour regulations:

"We all did it and survived"
"sign out to the next shift worker"

I bet this goes through, and 10 years of surgeons are trained with it, then they cut down to the 56 hour work week, and all the newly minted docs will complain just like we are now.

I'm only upset about it as a brand new PGY-1. Depending on how my program responds to the new requirements, I'm a little worried I will have to be an "intern" twice (i.e. as a PGY2 we will end up having to fill in the call schedule).

 

[glade]

I could care less if the patient thinks of me as the help. I care about how I see myself and about how my interns see themselves. If you want to think that you are just "the help" and that gets you thru the day then thats fine. I rather my guys feel like they can hang and deal with the crap that gets thrown their way, that they feel some pride it their work and in the service they put in in the middle of the night.

Yeah, I'm sure when you're on call at night you're sitting around feeling proud about your work and shining the medals you hang all over your white coat and brushing off the epaulets you sewed onto your shoulders.

 

[Fah-Q]

"Of added concern are reports suggesting that the 2003 limits did not increase residents’ hours of sleep4 or reduce fatigue5,6 and that the added time created under the new standards is not being used by residents for reading and study. Most important, studies using national data samples failed to show that the duty-hour limits had a positive effect on the quality and safety of inpatient care.7"

That's fantastic. The previous rules did not accomplish what we said they would and so let's pass more rules. How's that for evidence-based medicine?

This will further degrade the quality of training available in the US. Soon, there really won't be much of a difference in quality between a US residency graduate and a foreign residency graduate or physician assistant or nurse practitioners. The midlevel providers are happy to watch us destroy ourselves so they can advance their equivalency agenda. We are slowly turning doctors into shift nurses. Sad.

 

[Guile]

"Of added concern are reports suggesting that the 2003 limits did not increase residents’ hours of sleep4 or reduce fatigue5,6 and that the added time created under the new standards is not being used by residents for reading and study. Most important, studies using national data samples failed to show that the duty-hour limits had a positive effect on the quality and safety of inpatient care.7"

That's fantastic. The previous rules did not accomplish what we said they would and so let's pass more rules. How's that for evidence-based medicine?

This will further degrade the quality of training available in the US. Soon, there really won't be much of a difference in quality between a US residency graduate and a foreign residency graduate or physician assistant or nurse practitioners. The midlevel providers are happy to watch us destroy ourselves so they can advance their equivalency agenda. We are slowly turning doctors into shift nurses. Sad.

Got a link for that quotation? Judging from the numbers in the sentences it has a few references I'd be interested in reading.

 

[Fah-Q]

Got a link for that quotation? Judging from the numbers in the sentences it has a few references I'd be interested in reading.

The NEJM article should be attached.

 

[JackADeli]

...Of added concern are reports suggesting that the 2003 limits did not increase residents' hours of sleep or reduce fatigue and that the added time created under the new standards is not being used by residents for reading and study. Most important, studies using national data samples failed to show that the duty-hour limits had a positive effect on the quality and safety of inpatient care...

That's fantastic. The previous rules did not accomplish what we said they would and so let's pass more rules. How's that for evidence-based medicine?...

The failure to advance education in just about every area is a human error. "we" have tried to soften education environments at all levels in just about all apsects. What we have ended up with is high school students remediating in college, 4 year undergrad degrees taking 5+ years to complete, etc...

The intent of the [ACGME] rules are clear. It was to improve the education & learning environment while promoting patient safety. The theory was that the rules would enable more rest and study. Monitoring implementation has depended greatly on the lowest ranking individuals in the equation speaking up and reporting violations. Success of the study/self learning also depends on these same individuals. Instead, what I saw was plenty of "us" suddenly having time to actually live like our colleagues choosing a shorter path to a life. Suddenly, "we" were out to eat and/or drink more often. There was more "bonding" and partying. There was no real increase in reading. The failure of the residents to actually take responsibility and take advantage of the benefit they were handed is not something we can blame the ACGME about....

We do not have to look far on these websites and forums to find any number of softer gentler arguments and "social justice" type support arguments. We have plenty of mid-levels all but saying they should be equivalent to a physician without actually going through the same level of training. Plenty of "us" have argued how unfair it is that a MCAT, USMLE, or ABSITE score determines our career options. We can read numerous arguments about "poor tester". Cold hard fact is that by the time you are in medical school, you should really stop whining about those things and have already developed adaptation and strategies to overcome your difficulties. Instead, "we" look for "well rounded and more interesting applicants". Part of the well rounded aspect was to improve the "character composition" and limit the personality disorders. But, "we" have markedly diminished the classic "gunners" that would possibly use that study time and/or rest time. Keep in mind also that the decreased work hours attracted significant number of individuals [to surgery] because "it is now easier". Someone that has that mindset is not likely to instinctively put forth the effort during their "off duty hours".

Our compassion and desire to help people not fail is our greatest achilles heal in this country. IMHO, these are all just facets of a socialist/paternalistic mentality. "whitest socks" trophy at the end of the little league season. Increasing access to higher education even if folks may not be qualified for the program.... thus freshman at the university taking high school courses. Other individuals paying for your education instead of you working jobs/etc... like past generations. Developing ways for people to obtain degrees/etc... without actually having to do what was required. Demonizing people over how much they earn with their hard work and the years they put in while at the same time trying to bring "justice and equality" in pay without requiring same level of work. Allowing people to borrow money they don't have because "it's just right for everyone to be able to buy a home". Taxing the "wealthy" to redistribute to the "less fortunate". This is what America is right now. It permeates at all levels.

With the past or future ACGME rules, "we" could make leaps and bounds in medical/surgical education. Unfortunately, it would depend on "us". With our current social mentality, it will likely fail again. The next thing will be limited work hours combined with mandatory study halls... like for the college athletes.

 

[ESU_MD]

Dude, I dont think you can compare BUDS seal training with surgical residency.

However, surgery residency is long and it is hard. it is tough to have enough knowledge to practice safely AND be able to technically perform the operations without killing people.
It is more in depth than a plumbing apprenticeship, but does fall short of navy seals training intensity.

be that as it may. surviviing a 5yr residency is something you should be proud of.

Great residents will continue to shine whether they work 40hrs/wk or 120
Bad residents- no training can help them
however, those in between are the ones who the system needs to focus on and develop into surgeons.

instead of nite float, how about the mentorship model. 1 resident:1faculty. when the faculty is on call, so is the resident, at the office, home whatever. thats almost as close to real life as it gets.

 

[45408]

i'm sure theres no 80-hr limit to the navy seals hell week. we arent training to be cub scouts.

I could do just about anything for one week. It's the five year stretch that I'm a little more concerned about...

 

[JackADeli]

...i'm sure theres no 80-hr limit to the navy seals hell week. we arent training to be cub scouts...

I could do just about anything for one week. It's the five year stretch that I'm a little more concerned about...

I have never been to any special forces training. But, it is my understanding that for decades most individuals volunteering for special operations training ranger, SF, SEAL (?~60% drop rate in hell week), recon, etc.... have made the same claim and the majority have failed to back those claims. If anyting, the military has years of data showing the majority of individuals can NOT do it while at the same they claim they can. Hell, you don't even have to go to spec ops.... I think there is a significant drop out in basic combat arms training of the military ~i.e. infantry.

...In the past, we've had too many guys come try out for BUD/s who were not physically or mentally prepared...We can't grow our community by wasting time and resources bringing in people who have no chance of getting through the program...

 

[Guile]

I have never been to any special forces training. But, it is my understanding that for decades most individuals volunteering for special operations training ranger, SF, SEAL (?~60% drop rate in hell week), recon, etc.... have made the same claim and the majority have failed to back those claims. If anyting, the military has years of data showing the majority of individuals can NOT do it while at the same they claim they can. Hell, you don't even have to go to spec ops.... I think there is a significant drop out in basic combat arms training of the military ~i.e. infantry.

I'm pretty sure he was referring to general surgery training, not SEAL training, hence the "five year stretch" part.

 

[DRshooter]

Yeah, I'm sure when you're on call at night you're sitting around feeling proud about your work and shining the medals you hang all over your white coat and brushing off the epaulets you sewed onto your shoulders.

You're right, I'm very proud and so are my fellow residents. I rather be taken care of by a surgeon that takes pride in his work than a cynical one...but to each his own.

 

[indo]

Those sissy interns....err, those sissy 3rd year medical students whom this change would "benefit".

 

[JackADeli]

...i'm sure theres no 80-hr limit to the navy seals hell week. we arent training to be cub scouts...

I could do just about anything for one week. It's the five year stretch that I'm a little more concerned about...

I have never been to any special forces training. But, it is my understanding that for decades most individuals volunteering for special operations training ranger, SF, SEAL (?~60% drop rate in hell week), recon, etc.... have made the same claim and the majority have failed to back those claims. If anyting, the military has years of data showing the majority of individuals can NOT do it while at the same they claim they can. Hell, you don't even have to go to spec ops.... I think there is a significant drop out in basic combat arms training of the military ~i.e. infantry..

...In the past, we've had too many guys come try out for BUD/s who were not physically or mentally prepared...We can't grow our community by wasting time and resources bringing in people who have no chance of getting through the program...

I'm pretty sure he was referring to general surgery training, not SEAL training, hence the "five year stretch" part.

I guess I will leave the interpretation to each reader as to what was said/intended in context by, "I could do just about anything for one week...".

On another note, back to ACGME

...Do you think reducing hours will decrease fatigue? ...When I'm post-call, I don't sleep until that night. With the new 16 hour rule, If I go on at 8 PM and get off at noon, I won't go to bed until 11 PM. What is the point? I haven't gained rest and will be just as fatigued, if not more because I have 4 crazy kids at home...

I didn't have to go far... as I commented, IMHO, it's our choices and priorities that has caused a failure in progress with the current ACGME guidelines. It is not the fault of the ACGME if we choose not to use the increased hours off for sleep and study.

 

[glade]

You're right, I'm very proud and so are my fellow residents. I rather be taken care of by a surgeon that takes pride in his work than a cynical one...but to each his own.

That's cool. I'd rather be taken care of by a surgeon who wasn't a tool.

 

[ESU_MD]

I could do just about anything for one week. It's the five year stretch that I'm a little more concerned about...

well, it may be a paradox.

what about working in a fairytale residency land 9-5pm for 5 years.

Then on day 1 of the rest of your life you have to take call for your practice for the whole weekend, or even all week?

I find it quite surprising there isnt much push to enact work hour restriction for attendings.

 

[deleted89854]

I found the extra hours off instrumental in doing well on the ABSITE, as did most of my co-residents. Taking call and treating patients is instructive and teaches good patient care, but it's worthless in preparing for the exam. I'm not sure how accurate it is to say that all of us are using our extra spare time for drinking and going out.

 

[TheGrog]

I find it quite surprising there isnt much push to enact work hour restriction for attendings.

Like they have with airline pilots? I wouldn't be suprised if some day they (don't know who) tried. I would bet in 10 years something along this line was enacted.

 

[Ronin2258]

I find it quite surprising there isnt much push to enact work hour restriction for attendings.

And I know the attendings busted their posteriors at my residency. I saw them come in to do an emergent case at 11pm or later, and go to clinic or a full day in the OR when my senior and I were post call. 30 hours of heightened awareness and alertness I have no problem. Past 30, that edge blunts quickly.

I know these rules are meant to make help the house staff. And to be quite honest, I enjoyed my program's set up. 27-hour (NY) or 30-hour (most other places,) was quite tolerable and sign out was methodical. I can't see going shorter than 27 *and* still have the ability *not* to leave things hanging.

Attendings have no such rules in place. As we have seen, all it takes is one bad outcome in the wrong place at the wrong time with the wrong people to cause pressure to address the issue, whether by a self policing agency, or by a federal agency (like OSHA.)

And if we are going to go with the military for allusions, I have a couple for your, regarding rest periods. Weapons loaders for fighter jets have to have 8hrs off in 24hrs (i.e. a 16hr day,) because they have to handle things that go *boom* surprisingly easy. Nuclear-rated weapons loaders can only work 14hrs, due to the sensitive nature of the devices (i.e. big badda boom.) Now, it may have changed since I have been out of the service, and out of contact with my buddies who were weapons loaders, but I can't see it myself.

For myself, I consider us to handling patients with the same delicacy and attention to detail as my friends in weapons describe their jobs; in both jobs, if something goes wrong, the results are lethal. And that attention fades as the hours go on.