How many gen surgery spots unfilled last year?

[travoltage]

does anybody know how may gen surgery spots were vacant after last years match? i was just curious and couldn't find the answer anywhere

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[Castro Viejo]

does anybody know how may gen surgery spots were vacant after last years match? i was just curious and couldn't find the answer anywhere

You can find the answer on the AAMC website, but I think it was just one categorical spot.

Every year since the match for the entering General Surgery Class of 2003 it's been AT MOST three categorical spots in the country. That followed, of course, the entering Class of 2002 who saw 53 open spots and, before them for the Class of 2001, like 80+ spots I think.

It's been a wild ride in General Surgery land.

Part of this is a renewed interest in General Surgery generally speaking. I personally believe that much of it has to do with the ACGME nationalization of the 80 hour work week rules. The incoming interns and applicants you meet today are much more of the clock-watching bunch and have more questions regarding their lifestyles in and out of the program. I also question their work ethic as surgeons.

"What time do we round in the afternoon?"

"Do we get to go home after we round?"

"Do we have to stay for that case if it's going to start after 4PM?"

"Hey, Castro, it's almost 9AM. I'm post-call and I've gotta get home or else I'm gonna go over 80 hours this week."

"Hey, Castro, it's almost 4PM. I think we should start rounds because if we don't, I'll be here past 6PM and then I'm definitely gonna be over 80 hours this week."

"Hey, Castro, it's me, your intern, calling from the OR. Can you send someone to scrub me out so that I can go home? It's 3:30PM and I promised my husband that I'd pick up our daughter today."

"I know you're about to take this multiple gun shots to the belly case to the OR, but man, it's 5PM and I promised my girlfriend that I'd meet up with her for dinner tonight. Maybe next time, OK?"

"No, I can't make it this Saturday for the Chairman's Rounds. I have to set up for our yard sale this weekend. Please apologize to the Chairman for me and tell him I'm just too busy."

"No, sorry. I didn't get those lines put in overnight or finish up those consults I told you I'd do. My breasts were just so engorged that I spent most of it pumping them and then I just got so tired and then my husband called and my son said the cutest little thing and oh here's a picture of him and . . . "

"Hi Chief. It's me, your intern. I'm hoping to study for the ABSITE this month, so can you not assign me to any cases or to the clinic?"

And finally, although I could write more all night long...

"Chief, you know, where I went to medical school, the interns took care of the primary patients on the service and the Chief Resident wrote up all the consults and followed them on his own."

My response: "Then why don't you pack up your bags and go back to your med school's residency program? I'll drive you."

So, yeah, work ethic and attitude has changed somewhat. I'm not so much older, but I sometimes feel like I came from a different time.

 

[Blade28]

Great summary! Sad but true.

 

[Percival]

What, so you're suprised people want to have a life? You know, divorce sucks.

By the way, at my medical school, one of our professors just got behind an intern at the red light right off campus. He'd fallen asleep at the red light while driving home after his shift. 30 minutes earlier, he was seeing patients. Make a lot of sense to you? Would you want him caring for one of your parents?

 

[SLUser11]

So, yeah, work ethic and attitude has changed somewhat. I'm not so much older, but I sometimes feel like I came from a different time.

Did you do seven years of residency, or just five? If just five, then I don't know how much "back in my day" crap you can pull because you started training after the 80 hour rule took effect.

 

[Castro Viejo]

Did you do seven years of residency, or just five? If just five, then I don't know how much "back in my day" crap you can pull because you started training after the 80 hour rule took effect.

Yes, but many General Surgery programs, including my own, didn't come into compliance until a couple of years after I had started. So it wasn't until my third year that I was asked gently to go home post call. In my first two years of residency we were in the hospital post call every day until the late afternoon/early evening.

 

[Castro Viejo]

What, so you're suprised people want to have a life? You know, divorce sucks.

By the way, at my medical school, one of our professors just got behind an intern at the red light right off campus. He'd fallen asleep at the red light while driving home after his shift. 30 minutes earlier, he was seeing patients. Make a lot of sense to you? Would you want him caring for one of your parents?

No, I'm not surprised people want to have a life. I want to have a life too. But I have an obligation to my patients and to my team to help out as much as I can before I even begin thinking of going home.

It's also becoming more and more firmly established that since the implementation of ACGME work hour rules, medical ERRORS and patient MORTALITY have NOT improved. So you can subjectively believe that working more than 80 hours per week is going to negatively impact patient care, but the data wouldn't support your claim.

 

[Celiac Plexus]

What, so you're suprised people want to have a life? You know, divorce sucks.

By the way, at my medical school, one of our professors just got behind an intern at the red light right off campus. He'd fallen asleep at the red light while driving home after his shift. 30 minutes earlier, he was seeing patients. Make a lot of sense to you? Would you want him caring for one of your parents?

The 80 hour rule is a sham. The evidence thus far does not support the belief that an 80 hour work week reduces medical errors, or has any effect on patient mortality/morbidity.

What we do know is that the 80 hour rule is creating an army of shift mentality residents. I have heard pretty much the same lines from junior (and some senior) residents that Castro wrote.

I couldn't agree more that residents work hard. They are supposed to.

You owe your loyalty to your patients, and to your co-residents. Walking out on them is unacceptable for many of us.

 

[Percival]

On a side note totally unrelated to the OP, I have gained some insight on careers vs family life. It's painfully obvious.

No matter what the profession (I used to be in the Army, and it's especially true there), the sexier the job, the higher the honor, the higher the pay --- the more your family life is going to suffer. This is true 99.9% of the time. There is one man in a thousand who can have a demanding job and a great family life.

On the other hand, we are generally quick to label people derogatively as workaholics. We tend to look negatively on one who sacrifices their relationship with their wife and kids in order to achieve excellence at work. HOWEVER, society always has and always will need these people. All your great doctors, all your great generals, politicians, inventors, etc -- I'd bet you that just about each one had to make some family sacrifices.

I'm not making much of a point one way or the other, only that people should make an informed decision when they chose a career. Also women (I'm being sexist) should consider their husbands and what their calling is. Some women are called to be more independent and to support their husbands' demanding careers. Others are clearly not.

My wife is not so-called. She is not independent. And when I go to residency, I will not be volunteering to stay late (for the most part). Yes, I will want to go home after 80 hours. That's plenty of time to learn medicine. Patients will always be there -- my marriage is important to me. Many doctors are very, very bitter about life. One can pick that up by spending an hour on this website. I plan to stave off the bitterness by having some kind of balance.

My 2 cents.

 

[Castro Viejo]

My wife is not so-called. She is not independent. And when I go to residency, I will not be volunteering to stay late (for the most part). Yes, I will want to go home after 80 hours. That's plenty of time to learn medicine. Patients will always be there -- my marriage is important to me. Many doctors are very, very bitter about life. One can pick that up by spending an hour on this website. I plan to stave off the bitterness by having some kind of balance.

Good luck to you and your patients.

 

[smq123]

And when I go to residency, I will not be volunteering to stay late (for the most part).

Well, that effectively rules out surgery, ob/gyn, and critical care.

Yes, I will want to go home after 80 hours. That's plenty of time to learn medicine.

You're right, it is - if you extend all residencies by 2 years or so.

Think about it. A decade ago, your average IM resident was q4, working 100 hours a week, easily - and residency was 3 years long. Now, residency is STILL 3 years long, but most IM residencies have night float, and residents are working ~ 70 hours a week. If the practice of medicine is predicated on the idea of experience, then it's really obvious that today's residents are getting less experience during residency than today's attendings did.

It's "plenty of time to learn medicine," but is it plenty of time to learn GOOD medicine?

And the problems with the 80 hour work week have more to do with the frequent change-over of care that patients are now subjected to on a daily basis. When THREE DIFFERENT teams (primary team, night float, and the team that takes care of the patient after the primary team signs out but before night float signs in) can be responsible for ONE patient on a medicine service, the chances of errors are increasingly high.

Patients will always be there -- my marriage is important to me.

Patients will always be there?!?

There are things called "code blue" and "respiratory decompensation" and especially "death" that, in fact, make sure that some patients will NOT always be there!

If you suspect that there is a high probability that one of your patients will experience one of the three things previously mentioned, you can't just leave and hope night float is having a lucky night. You can't just dump an unstable patient on the night float team, who is not familiar with this patient! (And, furthermore, night float is usually responsible for >3 services at the same time - a tricky phenomenon called "cross cover.") You MUST, at some point, man up and realize that you have a lot of responsibility for your patient.

I foresee a future in PM&R, Emergency Med, path, or derm for you. Good luck.

 

[SLUser11]

The 80 hour rule is a sham. The evidence thus far does not support the belief that an 80 hour work week reduces medical errors, or has any effect on patient mortality/morbidity.

What we do know is that the 80 hour rule is creating an army of shift mentality residents. I have heard pretty much the same lines from junior (and some senior) residents that Castro wrote.

I couldn't agree more that residents work hard. They are supposed to.

You owe your loyalty to your patients, and to your co-residents. Walking out on them is unacceptable for many of us.

I can see how these types of residents can be extremely frustrating, and I have to admit that I don't know how negatively the 80 hour rule has impacted the Northeast.

(Side question, hasn't a work hour rule been in effect in New York for years due to the Libby Zion case?)

All I can say is that the 80 hour rule doesn't negatively affect my education. This is likely because myself and my co-residents take 24-7 home call. There isn't a shift work mentality, and you're not checking your patients out to cross-covering residents in a quantity and manner that invites oversights and mistakes.

Instead, you:
1. Maintain patient ownership.
2. Get experience doing things the way they'll be when your out in practice.
3. Get home at a decent hour and prevent your spouse from resenting you.


Our night float sees new consults and covers late OR cases. They check the new patients out to us in the AM. We are on call q 14 days (on the weekend), and get 2 weekends completely off, without a pager, per month. Since we are rarely post-call, we're not missing any afternoon cases.

If there is a patient concern that we can't handle over the phone, we call the night float resident to see the patient.


Something to think about......5-10 years from now, I wouldn't be surprised if a lot of programs across the country utilize a system similar to ours. It seems to be the only way to be 80 hour compliant without compromising resident education or patient care.

 

[Percival]

SMQ, when I said that patients would always be there, I meant patients in general -- obviously not one particular patient. I had assumed that you did not imagine that I thought that a single patient would always be in the hospital.

What I meant was that you will never heal everybody. At some point, a man has to go home.

As far as 80 hours not being enough to learn GOOD medicine, I offer this paralellism. One of our curriculum advisors told us at the first week of medical school that studying longer and harder was not always the solution to improve grades. I didn't listen to her, and discovered it on my own when my brain melted on a biochem exam after pulling an all-nighter. Yes, I passed it, but I could have done much better with rest.

How much is a resident REALLY taking in during the 90th hour of a work week. I mean, is it all actual LEARNING that is going on during those last 20 hours, or is it just b-tch work? I'm only an M1, but common sense tells me that just because you work 25% longer in a work week doesn't mean you learn 25% more.

I'm a non-traditional student. That may tell you something about me. I didn't grow up dreaming about stethoscopes. I think it's possible to take care of people and have personal balance as well. FYI, I do plan to study something general (but none of the fields you mention).

 

[Percival]

By the way, I have max respect for you guys. I tell my friends that if my dad needs a CABG done, I want it done by the guy who's an alcoholic and been married 3 times (I'm making a point, not saying you fellas are lousy husbands are anything). For a complex procedure, you don't want the guy (like me) who watched all his kids' little league games and is a Boy Scout master on the side. We need workaholics. I'm just not one of them, and you can't blame people like me for feeling that way.

 

[Percival]

By the way SMQ, if your profile is right and you're a medical STUDENT like me, I would imagine you'd be less heated about the 80 hour work week. I'm not suprised to take flack from Castro, but I don't ascribe a lot of merit to a medical student telling me how residency should be.

 

[SoCuteMD]

(Side question, hasn't a work hour rule been in effect in New York for years due to the Libby Zion case?)

Ironically enough, it's actually LAW in New York. Which doesn't seem to actually have any affect on compliance based on personal experience and word on the street.

 

[countryboy75]

I am a little unclear on this as I am only a third year. However, if a resident elects to go over the 80hr limit is there a penalty?

For instance, if there is an interesting case that I would like to work on coming in the afternoon or the hospital gets slammed patients, can one voluntarily go over?

 

[Castro Viejo]

(Side question, hasn't a work hour rule been in effect in New York for years due to the Libby Zion case?)

Yes. "The 405s" are state education and health laws which have been around since the late 1990s after the Libby Zion case. The problem with the 405s as they were originally written was not enough bite, and so programs basically policed themselves, and what do you think a New York hospital administrator who's strapped for cash said to the 405s?

In consequence we continued working well past 80 hours per week, even after the State of New York's Health Commissioner realized it was still going on, got the State Attorney General involved, and came down hard on every hospital citing work hours violations and slapping fines. So the hospitals started wising up and there was much more policing by the Department of Health on programs and PDs who were known to violate the hours often. My program was cited several times and slapped with a lot of fines. And it was about that same time that the ACGME adopted the 80 hour work week nationally for all their accredited programs.

But it took several more years before each program became compliant.

 

[smq123]

What I meant was that you will never heal everybody. At some point, a man has to go home.

A person has to go home at some point, I agree. But only once you've made sure that your responsibilities (i.e. your patients and your fellow residents) are settled in. Once you've made sure that you haven't left any loose ends dangling - especially any loose ends that will trip up night float.

As far as 80 hours not being enough to learn GOOD medicine, I offer this paralellism. One of our curriculum advisors told us at the first week of medical school that studying longer and harder was not always the solution to improve grades. I didn't listen to her, and discovered it on my own when my brain melted on a biochem exam after pulling an all-nighter. Yes, I passed it, but I could have done much better with rest.

The situations are hardly the same thing. You're an M1, and yes - reading your syllabus for the 8th time is not high yield.

But I'm an M3. (Not a big difference, maybe.) My 8th routine ABG is going to be a lot better than my 1st (which sucked, by the way ). Unlike in M1 and M2, repetition is much more important. My first week of ob/gyn, I could barely open a needle driver with one hand. By my last week of ob/gyn, I was doing a passable job of sub-q skin closures. By my last week of gen surg, my resident was saying that I did a better job on skin closures than most interns. Practice makes perfect.

FYI, I do plan to study something general (but none of the fields you mention).

What do you plan on doing? Just curious.

By the way SMQ, if your profile is right and you're a medical STUDENT like me, I would imagine you'd be less heated about the 80 hour work week. I'm not suprised to take flack from Castro, but I don't ascribe a lot of merit to a medical student telling me how residency should be.

I am a third year med student - and I know that you're a first year.

I'm old school.

In all seriousness - my older sister is an intensivist, having specialized in pulmonary medicine/critical care. She is now responsible for an ICU full of sick patients. She started internship before the 80 hour rule, and started fellowship shortly after the 80 hour rule was implemented at her hospital. (Sucks for her, I know.) She's told me stories of how shockingly lazy some of the residents have gotten - and how willing they are to dump sick patients in her lap just because "they're going to go over hours." Stories about how consults are left undone (once she got a consult that ended mid-sentence!), or how unstable patients are dumped into night float's lap. This makes for crappy patient care.

When I came into the third year of med school, I started to think that if you're going to accept the privilege of operating on people or caring for them at their very sickest, you MUST be willing to accept certain (somewhat onerous) responsibilities. These responsibilities include having a plan of care in mind before you act - for instance, when you operate, know in advance what complications may come up. These responsibilities also include seeing a person's care through all the way to the end - they gave you the honor of taking care of their health. You owe them the courtesy of making sure that their care is never compromised by your carelessness - which means making sure that they'll survive the night before you leave the hospital to go home.

Obviously you came into medical school with a different idea about what constitutes "good patient care." But I can tell you that, in many specialties (such as surgery and ob/gyn), being a clock-watcher is not the way to achieve the goals that I've outlined above.

 

[Castro Viejo]

How much is a resident REALLY taking in during the 90th hour of a work week. I mean, is it all actual LEARNING that is going on during those last 20 hours, or is it just b-tch work?

What do you consider "bitch work?"

I sincerely hope you're not one of those future residents who thinks that graduate medical education is supposed to be all about dressing up in your white coat, coming to "work," and sitting in a lecture hall all day. This ain't medical school. But given your responses thus far, you're the first one out the door at 4PM.

For the education we receive as residents we provide services (i.e., "bitch work") that allow the hospital to run cost-effectively. Yes, some of it is "scut" and non-educational, but there's nothing in ACGME guidelines that says you can't have scut as part of the residency (just not too much).

The 90th hour I spend in the OR doing what you might call "bitch work" is an education for me. The 90th hour I spend with my juniors in the SICU going over a complex case (i.e., "bitch work") is an education for them and me.

I'm a non-traditional student. That may tell you something about me. I didn't grow up dreaming about stethoscopes. I think it's possible to take care of people and have personal balance as well. FYI, I do plan to study something general (but none of the fields you mention).

Please promise me you'll just consult all your patients out to physicians who give a damn. Thanks.

 

[Castro Viejo]

I am a little unclear on this as I am only a third year. However, if a resident elects to go over the 80hr limit is there a penalty?

For instance, if there is an interesting case that I would like to work on coming in the afternoon or the hospital gets slammed patients, can one voluntarily go over?

No, you can't go over 80 hours per week.

The actual wording is you must not have worked more than 80 hours per week averaged over four weeks. So if you do stay for an "interesting case," then that time spent in the case is going to come out of somewhere else (i.e., coming in later in the day to start or leaving for home earlier). The problem is, if all the residents of the world started doing things like that, some patients won't get picked up until 2PM and some patients will be left hanging at noon. It's just not right.

I stay all the time if there's something interesting going on. I'm post-call today and stayed behind for a ruptured AAA repair and then hung around waiting for a laparoscopic adrenalectomy (had only seen one other in my career here). So I violated those work hour rules that the ACGME publishes. I was supposed to go home by 9AM, since I can't be directly involved in patient care activities for more than 24 hours at a time with a 6 hour grace period for sign-outs. Oops. And I'll continue to do it because my education, training, and my patients depend on it.

 

[Percival]

Castro, you've got a case of what I like to call e-balls. You're getting all militant and personal on me -- calling me lazy. You have no clue.

How do you have time to get in nearly 3000 posts on SDN if you're working so hard anyway? That's many, many hours you could have spent in the library reading about patient care.

 

[Winged Scapula]

3000 posts in almost 9 years at SDN is less than a post a day. Castro is hardly one of the more prolific posters here (at least until recently).

 

[Castro Viejo]

Castro, you've got a case of what I like to call e-balls. You're getting all militant and personal on me -- calling me lazy. You have no clue.

E-balls? Cute. I never used "lazy," but hey, if the shoe fits...

How do you have time to get in nearly 3000 posts on SDN if you're working so hard anyway? That's many, many hours you could have spent in the library reading about patient care.

Dunno. It just happens. Sort of like magic.

 

[travoltage]

castro you are the man! i love hearing your responses, every time im learning

 

[HouseHead]

I'd be interested in seeing a study about how the 80 hour week has impacted *resident* morbidity and mortality.

Lazy is lazy. I've done several sugery electives (I'm a MS4) and I really haven't seen many surgery residents shafting their patients or co-residents by leaving work unfinished. Those that do are generally either a) ortho residents doing their intern year on general, or b) very, very poorly regarded by their co-residents.

There are technical skills to be learned by repetition, which for some might validate the idea of spending every waking hour working (though the hour I once spent failing to place my 5th A line of the night- after hitting the first 3 flawlessly- might argue against that!). But personally I do find that things like moderate amounts of food, sleep, and exercise help for physical and intellectual stamina; these are all sacrificed when you're looking at having less that 48 hours a week for *everything* non-work related (as in the "good old days" of 120 hr weeks in surgery).

And wow, there are some insanely sexist comments in this thread. I've worked with lots of great people at every level, both female and male. But... frankly I've been more impressed with the female residents as a whole than the males. And so far I've been most impressed with the female surgery attendings, some of whom are just bad-a**!

 

[Castro Viejo]

I'd be interested in seeing a study about how the 80 hour week has impacted *resident* morbidity and mortality.

It hasn't done anything to it. If anything resident education has been negatively impacted and this is reflected in the overall lower board passing rates.

And wow, there are some insanely sexist comments in this thread.

Where?

 

[Pir8DeacDoc]

When I came into the third year of med school, I started to think that if you're going to accept the privilege of operating on people or caring for them at their very sickest, you MUST be willing to accept certain (somewhat onerous) responsibilities. These responsibilities include having a plan of care in mind before you act - for instance, when you operate, know in advance what complications may come up. These responsibilities also include seeing a person's care through all the way to the end - they gave you the honor of taking care of their health. You owe them the courtesy of making sure that their care is never compromised by your carelessness - which means making sure that they'll survive the night before you leave the hospital to go home.

Obviously you came into medical school with a different idea about what constitutes "good patient care." But I can tell you that, in many specialties (such as surgery and ob/gyn), being a clock-watcher is not the way to achieve the goals that I've outlined above.

I love it when third year medical students preach about commitment to patients and the like. truly heart warming....

 

[smq123]

I love it when third year medical students preach about commitment to patients and the like. truly heart warming....

Sarcasm duly noted.

But a lot of what I've seen from my residents has really impressed me. And isn't this what you bust a lot of ob/gyns and ER doctors for doing - half-assed workups, punting patients on to your service without examining them ("Looks good from door!"), operating on people and then not having a clue of how to fix their complications (that they've caused), skipping out early without finishing all their work.

If you complain about doctors who do these kinds of things to the med students who work with you, then don't be surprised if they absorb some of these ideas.

 

[europeman]

no one has brought up some of the good things that have resulted from the 80 hour workweek.... increased efficiency. I mean with PAs doing a lot of the scut, more time is left for operative/education experience by interns/residents.

Also, some of the really brutal practices of the past, which were COMPLETELY not educational are now a lot more limited. Back in the day some attendings would call their resident on Sunday afternoon to help with the most absurd, non-educational things. It's not a matter of work ethic, but absurdness.

The mentality of surgery training should *NOT* be one of service, but one of EDUCATION. If in order to get an ideal educatin you need to work over 80 hours, so be it. But at least there has been a shift in mentality. back in the days, the resident was a slave, who was there to serve the attendings beck and call. It should not be like that. Rather, residents are there to be educated; and granted part of that is service, it should not be to the degree where your education is inhibited.

 

[Castro Viejo]

The mentality of surgery training should *NOT* be one of service, but one of EDUCATION. If in order to get an ideal educatin you need to work over 80 hours, so be it. But at least there has been a shift in mentality. back in the days, the resident was a slave, who was there to serve the attendings beck and call. It should not be like that. Rather, residents are there to be educated; and granted part of that is service, it should not be to the degree where your education is inhibited.

Agreed. To a large degree scutwork has been minimized at most programs and now residency training, even at most county facilities, is kinder and gentler.

But I don't think this discussion regarding the 80 hour work week necessarily has to do with education, so much as it has to do with one's dedication to his team and his patients. That the younger breed of trainees, whether in Medicine, Pediatrics, OB/GYN, General Surgery, Orthopedics, etc., often have one eye on the clock all day just waiting for the "right time" to ask to round so that they can get out. This includes residents in my cohort who were just hitting internship at the time the ACGME made national the 80 hour work week tht started in New York.

So this newer breed of clock watchers have trained in an era where a shift worker mentality is okay, even as a physician. So, let's be real. If I had a shift worker mentality, why on Earth would I work up the guy who just hit my service with chest pain when it's five minutes to the time I'm "supposed to leave?" I'd just leave it for the next guy 'cause the workup I need to start is going to take at least another hour. So the patient gets ignored for the next five minutes and about another hour because of the "change in shift" underway with the residents.

Have you guys ever been a patient?

Have you ever been a patient in need of stuff during the 7PM shift change for the ancillary staff? YOU CAN'T GET ANYTHING from 7PM to 8PM.

And as for the house staff, especially those in medicine who end their shift at 4PM, try giving one of them a page after 3:30PM. That's right. No answer. And the guy who's on short call that night is going to be collecting sign-outs from a ton of interns for the next 2 hours, so that's another window during which there is no patient care and pages get ignored.

I'm all for everyone enjoying their residencies and learning as much as possible, but when you tell me that 80 hours is the most one can work and learn effectively in a week and you stick to it like it'll be the end of your life if you went just one minute over 80 hours for the week, I don't buy it. I am damn sure that the clock watchers in the group will be MORE THAN HAPPY if their Senior or Chief Residents rounded at noon and sent everyone home at 3PM. Where would all the crying go then? All the "but what about our education time?" Will you then take the hours saved on that day and add them to another to round out the 80 hours for the week? I'd bet not. My experience having done this for the last four and half years is that people don't tend to complain when you take work away from them (even if that means you ground them from the OR for a while), but they'll P&M when you try and get them to stay just a little longer to help out.

And to make residency training even more diluted, the ACGME is now considering lowering the work hours per week to 65.

 

[travoltage]

besides all the 80hr shift discussions.....back to the question of this topic..

where can i find a spreadsheet with the data of unfilled gen surgery spots?

 

[jubb]

I think the major drawback of the 80 hour work week is that it stifles ownership of the patients and breeds "it's not my problem" kind of mentality. I'm a Med 4, and I'm surprised at some of my fellow classmates/applicants when they are so concerned about having the lowest number of hours. I'm all for lots of hours, I wanna get trained and get experience. I'm all for efficient hours. That being said, I don't want to sit around all day waiting for a attending so we can round and I don't wanna do hours of discharge paperwork everyday after I mastered it in the first couple months, so hopefully the residency I end up has very efficient ways of working out those issues. I want to operate and I want to take care of sick patients. If that means staying a full day after call, I'll be more than happy to stay. If that means staying hours and hours after on regular non-call days I'll do it. I'm married and I love my wife dearly and love being at home, but you can't go home till the work is done. You are going to have to take full responsibility for your patients if you go into private practice, you'd better get used to it so you don't get bounced out of the first practice you join for being a panzy.
I'm not looking forward to dealing with whiney co-residents.

 

[MR1]

And to make residency training even more diluted, the ACGME is now considering lowering the work hours per week to 65.

Are you serious... How would that be even possible for everyone except maybe derm??

 

[Amgen1]

no one has brought up some of the good things that have resulted from the 80 hour workweek.... increased efficiency. I mean with PAs doing a lot of the scut, more time is left for operative/education experience by interns/residents.

I find this to be one of the great myths that accompany midlevels. this concept that they improve efficiency is very questionable in my opinion. With the infusion of midlevels on several of our services I have seen several things:

1. the residents are still ultimately responsible for the pts seen by the midlevels. so these pts end up being rounded on/ taken care of by the residents b/c they know they are ultimately responsible

2. Midlevels are given a list of chores to do after AM rounds. invariably, at 2pm or 3pm whenever the midlevel wants to leave, they find an intern, and check out the list to the intern. more often than not that list almost identical to the list they were given in the am (minus 1-2 tasks)

3. when a service has an influx of pts, the midlevels cap out. residents end up picking up the slack. When asked to see more pts, the midlevels stated they did not feel safe seeing more than 3 pts a piece

4. midlevels are getting paid 95K+, work no weekends, take no call, and try to leave most days by 2pm

That is not to say that they have not improved the paperwork some, but at the cost of 95K a yr, I question their "value". In addition, there is no accountability on their part. the residents are still ultimately held responsible for getting the work done

 

[Pir8DeacDoc]

Sarcasm duly noted.

But a lot of what I've seen from my residents has really impressed me. And isn't this what you bust a lot of ob/gyns and ER doctors for doing - half-assed workups, punting patients on to your service without examining them ("Looks good from door!"), operating on people and then not having a clue of how to fix their complications (that they've caused), skipping out early without finishing all their work.

If you complain about doctors who do these kinds of things to the med students who work with you, then don't be surprised if they absorb some of these ideas.

I hear where you are coming frmo and I imagine we agree on this more than we don't. I just think it's funny that a medical student is giving grief to people for being "lazy". It's not that you haven't done some stuff along the way, but it's hard to know what it's like without actually having been there.

 

[smq123]

I just think it's funny that a medical student is giving grief to people for being "lazy". It's not that you haven't done some stuff along the way, but it's hard to know what it's like without actually having been there.

Fair enough.

But I've seen my chief residents get burned by lazy juniors - which also taught me that a cranky chief makes for a miserable med student.

Even though I'm just in med school, I've also (unfortunately) gotten burned, on a number of occasions, by lazy med students and even lazy residents. So while it might be a bit premature, I've seen enough to know that I DON'T want to be one of "those" residents - or to have one of them in my program with me....

besides all the 80hr shift discussions.....back to the question of this topic..

where can i find a spreadsheet with the data of unfilled gen surgery spots?

Please clarify your question. Unfilled PRELIM gen surg spots? Or unfilled CATEGORICAL gen surg spots? There were only 2 unfilled categorical spots last year - http://www.imgresidency.com/Statistics.html

The data of unfilled categorical gen surg spots would make for a pretty short spreadsheet, I'm afraid.

There were plenty of unfilled prelim gen surg spots - I would imagine that this is the case nearly every year. A listing was posted by the SDNer formerly known as Kimberli Cox on this thread: http://forums.studentdoctor.net/showthread.php?t=380096

 

[Pir8DeacDoc]

I hear where you are coming from.

When you are a student it's easier to be all gung ho for the two months you're on the surgery rotation. However, maintaining that energy day after day and month after month is a lot tougher. There is no psych rotation scattered in there to let you catch up on your sleep and social life. I'm a hard worker and would never leave anything for my colleagues to clean up behind. But , I can see how the hours and work have worn down some of the folks I work with. As a med student you can't really appreciate what that' like because you only see us for a brief glimpse in time without the before or the after. Ok pseudorant over, just sort of rubbed me the wrong way. Take care!

 

[smq123]

I hear where you are coming from.

When you are a student it's easier to be all gung ho for the two months you're on the surgery rotation. However, maintaining that energy day after day and month after month is a lot tougher. There is no psych rotation scattered in there to let you catch up on your sleep and social life. I'm a hard worker and would never leave anything for my colleagues to clean up behind. But , I can see how the hours and work have worn down some of the folks I work with. As a med student you can't really appreciate what that' like because you only see us for a brief glimpse in time without the before or the after. Ok pseudorant over, just sort of rubbed me the wrong way. Take care!

Warning well received!

No, I also know where you're coming from - I went from OB/gyn straight to 12 weeks of surgery, which made for about 4 months straight of very poor sleeping cycles (and very swollen ankles - I should've thought of TEDs ).

By only the second month of surgery, I was very tired and cranky - which made me even more impressed by the work ethic of some of the surgery chiefs that I was allowed to work with. (That they could maintain that work ethic and, as cheesy as it sounds, compassion for their patients and their junior residents even after doing it for >5 years really amazed me. The experience also gave me some good role models to emulate.)

And it made me understand even better the concept that you shouldn't accidentally screw over your co-residents (or, in my case, co-students) by being complacent or lazy. You have enough crap to deal with as a resident - you don't have extra energy to deal with the crap that your co-residents leave for you to clean up.

To be truthful, part of that rant is probably also directed at myself - to remind me not to fall into the trap of letting "someone else deal with it." You're right - I can also see how easy it is to fall into that way of thinking. I just hope that I won't, but it'll require a lot of hard work to make sure that I don't.

And, honestly? It frightens me a little (as a future potential patient) that there is a FIRST YEAR med student who has already decided that he will rarely stay late as a resident....

 

[Percival]

Today we were fed lunch by the GS dept of my school. The two speakers were an attending trauma surgeon and a 4th year GS resident. They both liked the 80 hour work week. The attending said that she trained at a time when they worked 110 hours. She said that the 80 hour work week has given her more time to do other things -- like go to the library and research. She said that back in her day, there was absolutely zero educational reading going on after work.

As far as lazy, clock-watching residents/interns go, don't you think they'll get theirs in the end? I mean, don't the lazy people always get made known? Do you think they're really fooling anybody?

I would imagine that a great part of the 80 hour work week is time management anyway. The leadership needs to not take the time of their students for granted as much as they maybe used to. Sure, there will be the patient that needs your attention at hour 79 of your work week, and I would not expect any doctor with a sense of duty to skip out on a situation like that. But for the most part, don't you think people could go home after 80 hours (give or take 5 hours or so) if they were efficient with their time?

The caveat was that you have to be flexible with your off-time. In their own words, "If you did a breast surgery on a lady and that night she develops a huge hematoma, it's your problem. You have to take ownership of your own work."

 

[Winged Scapula]

Today we were fed lunch by the GS dept of my school. The two speakers were an attending trauma surgeon and a 4th year GS resident. They both liked the 80 hour work week. The attending said that she trained at a time when they worked 110 hours. She said that the 80 hour work week has given her more time to do other things -- like go to the library and research. She said that back in her day, there was absolutely zero educational reading going on after work.

The last sentence is true.

Yet for some reason average ABSITE scores and board pass rates are declining. Everyone said that with the lower work hours, residents would study more.

Guess what? They didn't. They used the time to spend with their spouse, to sleep, exercise, etc. NOT to read and "spend time in the library and research."

Blame it on working fewer hours meaning less exposure to clinical situations or caliber of residents. I tend to believe its the former but its too early to tell. Its also created a class of residents who believe that a fellowship is almost required...new data is out, percentage of residents seeking fellowships after general surgery is up, especially for females and residents in smaller programs. Make of it what you will, but it would not be unreasonable to think that some feel unprepared after 5 clinical years to go out into practice.

At least you got a free lunch out of it, but it sounds like typical BS that surgeons tell medical students and pre-meds to interest them in the field.

Working fewer hours has NOT resulted in less patient M&M, midlevels do not decrease the work you have to do (as stated very well above in the post by Amgen), and does not translate into higher ABSITE or board scores. Maybe we'll find residents are happier and there are fewer divorces but let's not paint this picture that the reduction in work hours has had any real positive effects on education.

But for the most part, don't you think people could go home after 80 hours (give or take 5 hours or so) if they were efficient with their time?

Hah...are you a Program Director?

That line is used so often to make residents feel guilty about not getting 120 hrs of work done in 80 hrs. Sure, there are times when some of the hours are not being used efficiently. But in many places, especially those where the work load is the same, if not worse (because of sicker patients) than it was in the pre-80 hr days and without a lot of midlevel help, you CAN'T get the work done in 80 hrs. In my experience, when programs violate work hours, often they turn the blame around onto the residents and state that if they were more efficient, the program wouldn't be in trouble.

The caveat was that you have to be flexible with your off-time. In their own words, "If you did a breast surgery on a lady and that night she develops a huge hematoma, it's your problem. You have to take ownership of your own work."

This is exactly what Castro and others are talking about. You take ownership and pride in your work and don't pawn it off on others. The situation you describe above happened to me in fellowship...except that the residents didn't call me because it was "after hours and we didn't want to bother you." It was 6 pm on a Friday and I WANT to be bothered when someone I've operated on has a complication. Its my patient and my responsibility...regardless of the hour, the day of the week, etc. Apparently this was a foreign concept to some of the residents there.

 

[jubb]

Maybe Absite scores went down because lazier people went in to surgery.

 

[Castro Viejo]

Are you serious... How would that be even possible for everyone except maybe derm??

Well supposedly surgical residencies (General, Ortho, Plastics, ENT, etc.) would get some kind of allowance of 10-15 hours or something like that, so it may not affect these types of residencies at all.

 

[Castro Viejo]

The attending said that she trained at a time when they worked 110 hours. She said that the 80 hour work week has given her more time to do other things -- like go to the library and research. She said that back in her day, there was absolutely zero educational reading going on after work.

Hold on there young stuff. This attending is bullcrapping you into thinking that attendings are limited to 80 hours of work per week over four weeks. The ACGME makes this provision for residents in training. NOT for attendings and certainly NOT for medical students. Attendings in private practice typically work well over 100 hours per week. Yes, that's right. Get used to it if being a surgeon is what you want to do.

Furthermore strict Trauma/SICU is a little more predictable, although not by much, because they tend to spend less time in the OR and more time on social work issues and SICU management. But if you're like most Trauma Surgeons, you're gonna have a General Surgery practice at the same time and your 80 hours per week goes right out the window.

And in regards of the "zero educational reading going on after work," as Kim Cox said, numerous studies and papers published since the work hours reforms have shown this to be true today in the era of the 80 hour work week. Residents aren't generally going home to study. They're going home to play Playstation, go to the bars, and pretty much have more of a life outside the program. And as my senior said, don't think there's anything educational about what the majority of residents are doing with hours 89-120.

As far as lazy, clock-watching residents/interns go, don't you think they'll get theirs in the end? I mean, don't the lazy people always get made known? Do you think they're really fooling anybody?

Yes, everyone knows they're lazy. Everyone wants to get them. But they've got the "law of the land" as dictated by the ACGME on their side. So what are you gonna do? To be honest, nothing can be done. What they do accomplish is creating a lot of resentment within the program and you, the Chief Resident, struggling to find someone -- anyone -- to pick up the slack.

But for the most part, don't you think people could go home after 80 hours (give or take 5 hours or so) if they were efficient with their time?

The caveat was that you have to be flexible with your off-time. In their own words, "If you did a breast surgery on a lady and that night she develops a huge hematoma, it's your problem. You have to take ownership of your own work."

I'm beginning to think that a small part of you does agree with what many of the surgeons here have been saying. I never said that you can't go home after 72 hours, nor did I say you must be over 80 hours every week to be a man in surgery. My point is that when there was never a stated limit, residents just kept trudging along and the goal was to get the team and their patients to a point where holding evening rounds and tidying up the service. Then and only then, and when the Chief Resident got out of the OR, it was time to go home. An efficient group of young 'uns could probably get this done by about 5PM. We can round and everyone would be out the door by about 7PM. No biggie. Other days maybe we'll even get to start earlier. Who knows?

But today the goal is no longer making sure your service is okay. It's not about making sure the team has accomplished as much as possible, because there's no real incentive. Everyone knows the limit is 80 hours. Everyone knows that they'll basically be sent home by default soon because they "can't go over hours." So the goal is to just try and avoid work as much as possible, hang out until the whistle blows, and you, as Chief Resident, are stuck with having to hear incessant complaints of "when are we gonna round? It's getting late," to the point that even MEDICAL STUDENTS are paging ME while I'm OPERATING to ask when we're gonna round.

I think to instill this kind of work ethic so early in one's medical education is wrong. Medical students need to understand that physicians are responsible to their patients AT ALL HOURS of the night. When my Whipple was dying the other night from his ischemic liver, I was at home post call on a Saturday night. I went back in to see him and to help the SICU resident figure things out (there wasn't much to do -- he was pretty much dead). I had to delay my dinner plans, but it was the right thing to do for a man who entrusted his life partly to my hands.

Today's medical students? Our affiliated medical school now has a rule that medical students on the surgical rotation go home post call. They're also not allowed to take more than four overnight calls per month. They're also instructed, supposedly, to go "just leave the hospital" by 4PM everyday IF the Chief Resident or Senior Resident haven't started rounds.

WTF?

 

[Castro Viejo]

Maybe Absite scores went down because lazier people went in to surgery.

Yes, that's part of it. But also part of it is loss of education time. What was once a 120 hour per week residency is now cut down by 1/3, and in the time lost, the data indicates that NO ONE is reading.

 

[ESU_MD]

incessant complaints of "when are we gonna round? It's getting late," to the point that even MEDICAL STUDENTS are paging ME while I'm OPERATING to ask when we're gonna round.

Today's medical students? Our affiliated medical school now has a rule that medical students on the surgical rotation go home post call. They're also not allowed to take more than four overnight calls per month. They're also instructed, supposedly, to go "just leave the hospital" by 4PM everyday IF the Chief Resident or Senior Resident haven't started rounds.

WTF?

This is another blood boiler for me. The medical students I have encountered over the past 4+ years have steadily declined in attitude. They are acting more and more entitled. yes, I too have been paged by medical students asking when are we going to round, and also to be told they are "postcall"

When I was a student, I couldn't even talk to a senior resident let alone the chief, let alone to bother him in the OR to ask to go home. The funny thing is that the vast majority of students rotating with me at the time felt the same way. I scold my interns for calling me in the OR without going through a few other levels. Sad...

If you want to go into surgery, you need to do it like everyone before you did it. just because you have kids or a wife or want to go to the movies and your chief is operating or whatever problems you have- nobody cares. suck it up.

I will continue to do what I think is proper and live up to the standards that Dr. Halsted has set in place for training surgeons. and that does not involve clockwatching

 

[smq123]

I think to instill this kind of work ethic so early in one's medical education is wrong. Medical students need to understand that physicians are responsible to their patients AT ALL HOURS of the night. When my Whipple was dying the other night from his ischemic liver, I was at home post call on a Saturday night. I went back in to see him and to help the SICU resident figure things out (there wasn't much to do -- he was pretty much dead). I had to delay my dinner plans, but it was the right thing to do for a man who entrusted his life partly to my hands.

Wow - that's a really eloquent way to put it.

Sorry to hear about your Whipple patient, though - it must have made for a pretty depressing Saturday evening.

Today's medical students? Our affiliated medical school now has a rule that medical students on the surgical rotation go home post call. They're also not allowed to take more than four overnight calls per month. They're also instructed, supposedly, to go "just leave the hospital" by 4PM everyday IF the Chief Resident or Senior Resident haven't started rounds.

What time are they allowed to go home post call? We were told by the rotation coordinator to leave by noon SHARP, but I never felt comfortable about speaking up and requesting to leave, so I usually stayed the full day the next day.

They're telling you that they've been instructed to leave by 4 if the team hasn't rounded yet? It sounds like you're hearing a well-coordinated lie by your group of med students. While the other stuff sounds plausible (i.e. I have heard of some rotations sites that put a limit on the number of overnight calls you can take - although this is generally more true of psych than of surgery - and of making students leave by noon post-call etc.), this sounds a little odd. This is ignoring the fact that you can't realistically expect every surgical service to start rounding by 4PM every day....

 

[Castro Viejo]

I will continue to do what I think is proper and live up to the standards that Dr. Halsted has set in place for training surgeons. and that does not involve clockwatching

Graduated responsibility, not graduated bitching.

 

[46&2]

besides all the 80hr shift discussions.....back to the question of this topic..

where can i find a spreadsheet with the data of unfilled gen surgery spots?

There is no spreadsheet. There was 1 or 2 categorical spots at Carillion Clinic in Roanoke open last year. That's it. Several prelim spots, however, at a variety of institutions.

 

[chrisisinnocent]

The 80 hour rule is a sham. The evidence thus far does not support the belief that an 80 hour work week reduces medical errors, or has any effect on patient mortality/morbidity.

What we do know is that the 80 hour rule is creating an army of shift mentality residents. I have heard pretty much the same lines from junior (and some senior) residents that Castro wrote.

I couldn't agree more that residents work hard. They are supposed to.

You owe your loyalty to your patients, and to your co-residents. Walking out on them is unacceptable for many of us.

It's this kind of mentality that allows hospitals to use residents as slave labor while they happily bill for your work under someone else's name.