"Let First-Year Residents Work Longer Shifts, ACGME Proposes"

[chipwhitley]

What do you think the typical schedule of a private practice surgeon who would be performing emergency surgery in the middle of the night is? Do you think they are working a 12 hour night shift?

When you call the GI doc or Cardiologist at 2 am, you do realize that we aren't there and we were the same guy you called the last night right?

Private practice is dying, anyway.

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[chipwhitley]

What makes you think the attending hasn't been working those kind of hours?

There are no work hour restrictions for attendings in practice. You take your child to a surgeon, especially those without resident coverage and its entirely possible they've been up for that long.

NB: I see that @Gastrapathy had the same post which hadn't loaded when I was typing mine (I"m mid-air).

My opinion is that no doctor should be working those kinds of hours, for the same reason we don't allow airline pilots or air traffic controllers or police/firefighters to be up for 28 hours. Given that, even if you end up having to work those hours as an attending, you don't have to prepare for the once in a blue moon that you'll be working 28 hours in a row by regularly working 28 hours in residency. And why are we so insistent that the interns, who are just getting adjusted to the system, have to do this? Isn't it enough that all the other years are doing it?

 

[ProfMD]

My opinion is that no doctor should be working those kinds of hours, for the same reason we don't allow airline pilots or air traffic controllers or police/firefighters to be up for 28 hours. Given that, even if you end up having to work those hours as an attending, you don't have to prepare for the once in a blue moon that you'll be working 28 hours in a row by regularly working 28 hours in residency. And why are we so insistent that the interns, who are just getting adjusted to the system, have to do this? Isn't it enough that all the other years are doing it?

1) It is not necessarily once in a blue moon.

2) Yes you do need to prepare for it.

 

[PL198]

What makes you think the attending hasn't been working those kind of hours?

There are no work hour restrictions for attendings in practice. You take your child to a surgeon, especially those without resident coverage and its entirely possible they've been up for that long.

NB: I see that @Gastrapathy had the same post which hadn't loaded when I was typing mine (I"m mid-air).

you're getting paid well to do so. I don't like the attending to resident comparison, just like I don't like the resident to intern comparison, . You're sleeping more during your shift than the resident, you know what you're doing more, etc etc

 

[Neopolymath]

.

 

[chipwhitley]

1) It is not necessarily once in a blue moon.

2) Yes you do need to prepare for it.

Maybe as a surgeon it's common, but I would be surprised to see a family doc, psychiatrist, dermatologist, radiologist, etc pulling 28 hour shifts even once in a blue moon, if ever. And I reiterate my question, why do interns need to start off in their first week pulling 28 hour shifts when they barely know what they're doing? It seems more than enough that every other year can already do these long shifts.

 

[Winged Scapula]

you're getting paid well to do so. I don't like the attending to resident comparison, just like I don't like the resident to intern comparison, . You're sleeping more during your shift than the resident, you know what you're doing more, etc etc

That wasn't the argument (paid or not). The question was did you want a tired physician operating on you.

1) surgeons don't work "shifts"

2) if you think a busy general surgeon is sleeping all night on call, then i'm not sure where to go next with this discussion; even I in my "lifestyle specialty" don't sleep all night

3) the resident is going home after 16 or 24 hours; the attending is not

The user complaining about having a tired resident suture or operate neglected to understand that out in practice, he doesn't know how long the attending has been up either.


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[chipwhitley]

After working in ORs for years, I have yet to come across anyone that thought this 16x6 nonsense was better than fewer, but longer days for any reason. It sure as **** isn't better from a lifestyle standpoint.

One thing that is clear is that most medical students these days haven't even had a job, much less one with demanding hours or physician like schedules before starting school. I think that explains their reactions.

How many jobs did you hold before med school that required you to work a 28 hour shift every 3-4 days?

 

[Neopolymath]

How many jobs did you hold before med school that required you to work a 28 hour shift every 3-4 days?

.

 

[Winged Scapula]

Private practice is dying, anyway.

What does that have to do with anything?

You think that when hospitals buy practices and employ physicians that they want you to work less and get more rest?

When local hospitals employ surgeons they often are required to take more ED call than they had in PP. It's a common practice in the community. If they allowed outside (non employed) surgeons to take that ED call, they would lose some revenue (namely the surgeon reimbursement).


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[IlDestriero]

What does that have to do with anything?

You think that when hospitals buy practices and employ physicians that they want you to work less and get more rest?

When local hospitals employ surgeons they often are required to take more ED call than they had in PP. It's a common practice in the community. If they allowed outside (non employed) surgeons to take that ED call, they would lose some revenue (namely the surgeon reimbursement).

You definitely don't want to work for the man.
All they care about is the bottom line.
You won't be working less, and if you do, you'll be making way less.
This has already played out in anesthesia. There are good and fair hospital owned groups, but that's not the norm and you're at the whim of the CEO, CFO, and what they think is fair, and you're more directly tied to the financial success of the hospital. Working for a management company is even worse. They're siphoning off your profits to the shareholders and paying you the minimum to keep your ass in the seat. As an example, a job that used to make partners 600s now pays them 350-400. For the same work, and minimal control. Lose-lose.


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Il Destriero

 

[VA Hopeful Dr]

1) It is not necessarily once in a blue moon.

2) Yes you do need to prepare for it.

No kidding. My father-in-law before he semi-retired from obstetrics did overnight call q5 which started at 9am and ended at 9am the next day, and that post call day was clinic until 5pm. Every 5th weekend he was in the hospital from Friday 9am to Monday 9am. Now admittedly he wasn't super busy all the time and did get at least a few hours but there were also nights where he didn't.

The OB my wife goes to is part of an 8 person group. They are high volume enough that when they take call, they don't get any sleep - period. Same schedule as I mentioned above.

 

[VA Hopeful Dr]

Maybe as a surgeon it's common, but I would be surprised to see a family doc, psychiatrist, dermatologist, radiologist, etc pulling 28 hour shifts even once in a blue moon, if ever. And I reiterate my question, why do interns need to start off in their first week pulling 28 hour shifts when they barely know what they're doing? It seems more than enough that every other year can already do these long shifts.

My PCP is part of a roughly 30 person group. That's enough patients that even when he's on phone-call only, he doesn't get any sleep that night. Granted its only once every 45 days or so, but still.

And for nonsurgical fields, interns might be able to get enough learning in doing 16 hour shifts but my opinion is that the old system was better.

The first half of my intern year we did the traditional overnight calls. Yes it sucked, but you had good post call days and golden weekends. The second half of my intern year we switched to 16 hour calls. 1 day off per week, no post-call days - to my mind it sucked worse. Since my wife worked, when I was doing night float I wouldn't see her for an entire week. Day shift was q3 and that meant getting home just in time to go to sleep. Compare that to q4 overnight it means I'd only be away roughly 2 nights per week, and the next day I'd be home when she got there and we could actually spend time together.

 

[PL198]

No kidding. My father-in-law before he semi-retired from obstetrics did overnight call q5 which started at 9am and ended at 9am the next day, and that post call day was clinic until 5pm. Every 5th weekend he was in the hospital from Friday 9am to Monday 9am. Now admittedly he wasn't super busy all the time and did get at least a few hours but there were also nights where he didn't.

The OB my wife goes to is part of an 8 person group. They are high volume enough that when they take call, they don't get any sleep - period. Same schedule as I mentioned above.

I wouldn't go to a doc personally where I know they are on a 28 hr shift and not able to sleep at all. Basic logic would assume drastically decreased functioning and cognitive function.

I get the longer shifts if you can get some sleep during which I think most can. Not talking about 8 hrs but at least 3-4+ . If you're truly getting no sleep for 28 hr that is a true safety issue that I think would be hard to argue against

 

[PL198]

That wasn't the argument (paid or not). The question was did you want a tired physician operating on you.

1) surgeons don't work "shifts"

2) if you think a busy general surgeon is sleeping all night on call, then i'm not sure where to go next with this discussion; even I in my "lifestyle specialty" don't sleep all night

3) the resident is going home after 16 or 24 hours; the attending is not

The user complaining about having a tired resident suture or operate neglected to understand that out in practice, he doesn't know how long the attending has been up either.


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Didn't say all night but there is a drastic difference between sleeping a few hrs and not being able to sleep at all. I bet those two individuals would function very differently.

Semantics on rhe shift word. During your call. Same difference. I haven't met many who say they get no sleep.

No I don't want an attending operating on me that has been up 16+ hrs without sleep. The literature on this is extremely clear.

 

[ProfMD]

Maybe as a surgeon it's common, but I would be surprised to see a family doc, psychiatrist, dermatologist, radiologist, etc pulling 28 hour shifts even once in a blue moon, if ever. And I reiterate my question, why do interns need to start off in their first week pulling 28 hour shifts when they barely know what they're doing? It seems more than enough that every other year can already do these long shifts.

And that is the whole point of relaxing the 16 hour rule. Let specialities and programs decide. If the IM/FP/whatever program moves to overnight call, pick a different program. But for surgical specialities, where we see value in overnight call, let us decide. Don't force rules that may work for IM or FP on surgeons.

That being said, there are also experienced non-surgeons posting here who agree that overnight call has value.

 

[IlDestriero]

Didn't say all night but there is a drastic difference between sleeping a few hrs and not being able to sleep at all. I bet those two individuals would function very differently.

Semantics on rhe shift word. During your call. Same difference. I haven't met many who say they get no sleep.

No I don't want an attending operating on me that has been up 16+ hrs without sleep. The literature on this is extremely clear.

Well, don't have emergency surgery between 9PM and midnight, because the likelihood of the surgeon being up at 6ish and not taking a PM nap yet approaches 100%.
Good luck with your search for a well rested surgeon for your emergent after hours/overnight case. The people I worry about are the elective patients the next day when I know that the surgeon had a long complex trauma case in the middle of the night and they have a full OR day in the AM. That doesn't happen in anesthesia, but surgeons often don't protect themselves from that.


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Il Destriero

 

[VA Hopeful Dr]

I wouldn't go to a doc personally where I know they are on a 28 hr shift and not able to sleep at all. Basic logic would assume drastically decreased functioning and cognitive function.

I get the longer shifts if you can get some sleep during which I think most can. Not talking about 8 hrs but at least 3-4+ . If you're truly getting no sleep for 28 hr that is a true safety issue that I think would be hard to argue against

Then best hope you/your wife don't go into labor outside business hours.

And I really don't think there is a major safety issue (mainly because if there was, we'd have seen it by now). One of the points of residency is to make much of what you do almost second nature. You'll see this happen in residency a few times - early on when you get paged you'll read up on the patient, try and figure out what's wrong, and go deal with is. Later, you'll barely wake up, ask the important questions, give a verbal order or two, and go back to sleep. I suspect (and maybe a few of our surgeons here can weigh in) that after a few thousand of a certain procedure, they could probably do it half asleep.

If you've done your surgery rotation already, you've probably already seen something like this. When early residents do procedures, they are usually extremely focused on the task, often want a quiet OR free of distractions. Attending surgeons (and later residents) by contrast can be chatting with everyone, listening to music, and still do the procedure and make it look easy. Being tired will affect outcomes less in the latter case.

 

[VA Hopeful Dr]

And that is the whole point of relaxing the 16 hour rule. Let specialities and programs decide. If the IM/FP/whatever program moves to overnight call, pick a different program. But for surgical specialities, where we see value in overnight call, let us decide. Don't force rules that may work for IM or FP on surgeons.

That being said, there are also experienced non-surgeons posting here who agree that overnight call has value.

This is the part that gets me every 4 months or so when this topic comes back up. I'm a family doctor, I don't teach, and I was right in the middle of the most recent rule change. It literally makes no difference in my life what resident work hours are and I saw both systems, while also benefiting from the 2003 rule change. What reason could I have, other than actually believing that restricting hours too much affects learning, to be against the current system.

 

[ProfMD]

Then best hope you/your wife don't go into labor outside business hours.

Not to mention heart attack, stroke, car accident, sepsis ...

I guess if you plan all major life events to happen 9-5 M-F then you can avoid seeing a doctor who has been on call.

 

[Winged Scapula]

You definitely don't want to work for the man.
All they care about is the bottom line.
You won't be working less, and if you do, you'll be making way less.
This has already played out in anesthesia. There are good and fair hospital owned groups, but that's not the norm and you're at the whim of the CEO, CFO, and what they think is fair, and you're more directly tied to the financial success of the hospital. Working for a management company is even worse. They're siphoning off your profits to the shareholders and paying you the minimum to keep your ass in the seat. As an example, a job that used to make partners 600s now pays them 350-400. For the same work, and minimal control. Lose-lose.


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Il Destriero

Boy don't I know it.

Our largest anesthesia group was purchased a couple of years ago. As I understand it, one of the requirements was more "house" coverage so that meant convincing hospitals where they weren't house, that they should be. Guess it looks good for the parent group.

All fine and dandy for the partners who got their payout from the purchase, but now the staff guys and gals are being forced to cover cases that several different groups used to cover, with only 2 weeks notice, and no pay increase.


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[Winged Scapula]

I wouldn't go to a doc personally where I know they are on a 28 hr shift and not able to sleep at all. Basic logic would assume drastically decreased functioning and cognitive function.

I get the longer shifts if you can get some sleep during which I think most can. Not talking about 8 hrs but at least 3-4+ . If you're truly getting no sleep for 28 hr that is a true safety issue that I think would be hard to argue against

I can't speak for others but i am extremely groggy with just a few hours of sleep (my usual is 5.5-6); i actually functioned better staying up than having an hour or two here and there. As other surgeons have noted, you do get used to the hours when doing them.

But as others have said, good luck with planning your healthcare around a 9-5 schedule.


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[chipwhitley]

I can't speak for others but i am extremely groggy with just a few hours of sleep (my usual is 5.5-6); i actually functioned better staying up than having an hour or two here and there. As other surgeons have noted, you do get used to the hours when doing them.

But as others have said, good luck with planning your healthcare around a 9-5 schedule.


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Or maybe we could just have another doctor work at night so no one would be up 24+ hours? I mean that's what happens in every other industry. We don't have to plan our flights around a 9-5 schedule because they have another set of pilots to take flights at night and no one ends up piloting for 30 hours straight.

 

[Winged Scapula]

Or maybe we could just have another doctor work at night so no one would be up 24+ hours? I mean that's what happens in every other industry. We don't have to plan our flights around a 9-5 schedule because they have another set of pilots to take flights at night and no one ends up piloting for 30 hours straight.

Sure -- where are you getting these physicians from? There aren't enough general surgeons to go around.


Don't get me wrong I do agree that there's room for improvement in work hours.


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[VA Hopeful Dr]

Or maybe we could just have another doctor work at night so no one would be up 24+ hours? I mean that's what happens in every other industry. We don't have to plan our flights around a 9-5 schedule because they have another set of pilots to take flights at night and no one ends up piloting for 30 hours straight.

Two problems with that. One, we'd need more bodies to do that. You can either hire someone to be the nocturnist or have your existing doctors take night float shifts but then they lose a week of clinic to do it. Two, despite what so many people seem to think, there is value in continuity of care - especially for emergent stuff. Again, surgeons can back me up, but if you've already been in a patient's belly once I would think you'd get better results if you're the one who goes back in again as opposed to someone new.

 

[ProfMD]

Or maybe we could just have another doctor work at night so no one would be up 24+ hours? I mean that's what happens in every other industry. We don't have to plan our flights around a 9-5 schedule because they have another set of pilots to take flights at night and no one ends up piloting for 30 hours straight.

Some residencies do that. Some people like it, some don't. Night float has pros and cons.

For many physicians in practice, that is not a sustainable model. Take me, for instance. I have two partners, so I am basically on call every third night. The majority of the time, I do sleep. You are suggesting that I take the day before and the day after call off just in case I don't get sleep. That leaves me one out of three days to see patients in clinic and do elective surgery.

Besides the toll that would take shifting from days to nights all the time, it is not sustainable financially. And, I actually like what I do. I don't want to take 2/3 of the weekdays off for 1 in 3 call. Alternating weeks or months has the same problems, just stretched out.

 

[ProfMD]

Two problems with that. One, we'd need more bodies to do that. You can either hire someone to be the nocturnist or have your existing doctors take night float shifts but then they lose a week of clinic to do it. Two, despite what so many people seem to think, there is value in continuity of care - especially for emergent stuff. Again, surgeons can back me up, but if you've already been in a patient's belly once I would think you'd get better results if you're the one who goes back in again as opposed to someone new.

Yes - even in surgery there is continuity of care. There is benefit for both the physician-patient relationship and patient care if one surgeon does the consult, the surgery, and the postop follow-up.

 

[Winged Scapula]

Yes - even in surgery there is continuity of care. There is benefit for both the physician-patient relationship and patient care if one surgeon does the consult, the surgery, and the postop follow-up.

Lets also not forget that PATIENTS prefer it as well. We form relationships with them, even short-lived ones, and patients feel more comfortable with "their doctor" than some guy just populating the call schedule.

Like Prof noted, taking days off pre and post call is just not feasible financially whether you're in private practice or an employed model. In addition, you need to be available to your patients in case they have a postop complication or other issue, not to mention needing days available in clinic for elective patients.


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[bannie22]

This is the stupidest paper and administrative reaction on earth

Any person with half a brain know that residents are cajoled into answering appropriately in these "questionaires" and anything else is unacceptable and can result in many unfathomable things

Anyone that thinks a human being working more than 16 hours in a row is not more likely to make mistakes should read all the studies that correlate performance no better than someone driving above the limit

And what about the long term costs to health? i havent seen any long term cohort studies but there is no doubt the cardiovascular and generalized health and wellness side effects in staying awake for inappropriately extended durations

The argument that people used to do it is asinine. people used to live in caves, used to be slaves etc

 

[ThoracicGuy]

This is the stupidest paper and administrative reaction on earth

Any person with half a brain know that residents are cajoled into answering appropriately in these "questionaires" and anything else is unacceptable and can result in many unfathomable things

Anyone that thinks a human being working more than 16 hours in a row is not more likely to make mistakes should read all the studies that correlate performance no better than someone driving above the limit

And what about the long term costs to health? i havent seen any long term cohort studies but there is no doubt the cardiovascular and generalized health and wellness side effects in staying awake for inappropriately extended durations

The argument that people used to do it is asinine. people used to live in caves, used to be slaves etc

 

[ProfMD]

This is the stupidest paper and administrative reaction on earth

Any person with half a brain know that residents are cajoled into answering appropriately in these "questionaires" and anything else is unacceptable and can result in many unfathomable things

Anyone that thinks a human being working more than 16 hours in a row is not more likely to make mistakes should read all the studies that correlate performance no better than someone driving above the limit

And what about the long term costs to health? i havent seen any long term cohort studies but there is no doubt the cardiovascular and generalized health and wellness side effects in staying awake for inappropriately extended durations

The argument that people used to do it is asinine. people used to live in caves, used to be slaves etc

What about all the papers that failed to show improved outcomes with institution of work hour restrictions?

I know your "feel" that fewer hours must be better, but the literature doesn't back you up.

Colbert called what you are experiencing "truthiness."

 

[PL198]

Well, don't have emergency surgery between 9PM and midnight, because the likelihood of the surgeon being up at 6ish and not taking a PM nap yet approaches 100%.
Good luck with your search for a well rested surgeon for your emergent after hours/overnight case. The people I worry about are the elective patients the next day when I know that the surgeon had a long complex trauma case in the middle of the night and they have a full OR day in the AM. That doesn't happen in anesthesia, but surgeons often don't protect themselves from that.


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Il Destriero

Right that was my point too about the elective. Obviously you can't really be picky for emergent and urgent stuff.

Aren't the big nursing bodies pushing against the 12 hr shifts now and want to go back to 8? Again not the same thing but similar concept

 

[bannie22]

Papers have shown poorer cognitive performance with extended periods without rest

Papers have shown no worse clinical performance

Have papers shown better performance without rest?
Why do you presume the status quo should be 16+ hours before it is proven that there is improved patient care?

Even the FDA ensures medication pass all levels of testing before it is available to the public (rather than make everything available and making a recall when its proven unsafe), much less the frontline manpower of health care

 

[VA Hopeful Dr]

Right that was my point too about the elective. Obviously you can't really be picky for emergent and urgent stuff.

Aren't the big nursing bodies pushing against the 12 hr shifts now and want to go back to 8? Again not the same thing but similar concept

Meh, I really think you're over-worrying. When my girls were first born, I bet I was only getting 2-3 hours of sleep per night and this went on for 3 months with maybe 1 night/week of decent sleep. This situation is not unique to me. Should I have taken all that time off of work? After all, I was getting less sleep than most surgeons.

 

[VA Hopeful Dr]

Papers have shown poorer cognitive performance with extended periods without rest

Papers have shown no worse clinical performance

Have papers shown better performance without rest?
Why do you presume the status quo should be 16+ hours before it is proven that there is improved patient care?

Even the FDA ensures medication pass all levels of testing before it is available to the public (rather than make everything available and making a recall when its proven unsafe), much less the frontline manpower of health care

HAHAHAHAHAHA. Yeah, tell that to Vioxx, Darvocet, DES, Avandia, Xigris, and so on

Plus, its up to the people who want a change to prove their way is better. We know the current way makes competent physicians. Prove your way does too before we risk changing.

 

[chipwhitley]

HAHAHAHAHAHA. Yeah, tell that to Vioxx, Darvocet, DES, Avandia, Xigris, and so on

Plus, its up to the people who want a change to prove their way is better. We know the current way makes competent physicians. Prove your way does too before we risk changing.

Actually the current max is 16 hours, we know it has been making competent physicians now for years so we want to leave it alone, you guys want to change it to 28, so you should be the one proving your way works better, no?

 

[VA Hopeful Dr]

Actually the current max is 16 hours, we know it has been making competent physicians now for years so we want to leave it alone, you guys want to change it to 28, so you should be the one proving your way works better, no?

Actually not. The doctors that did their entire residencies under the 16 hour rule have, at best, been out for 2 years. The surgeons affected by the changes (since they are the ones likely most affected) have been out for a mere 5 months assuming no fellowships, so no we really don't know if the new process makes competent doctors.

Really the only thing we do know about the 2011 changes is that they don't seem to make a difference in patient results and resident satisfaction among surgeons: https://www.absurgery.org/default.jsp?news_trial0216

 

[ProfMD]

Papers have shown poorer cognitive performance with extended periods without rest

Papers have shown no worse clinical performance

Have papers shown better performance without rest?
Why do you presume the status quo should be 16+ hours before it is proven that there is improved patient care?

Even the FDA ensures medication pass all levels of testing before it is available to the public (rather than make everything available and making a recall when its proven unsafe), much less the frontline manpower of health care

Right - the papers show patient safety is not compromised despite the fear that being tired impairs work. Theory vs practice. As @VA Hopeful Dr said, you need to show your way is better.

Actually the current max is 16 hours, we know it has been making competent physicians now for years so we want to leave it alone, you guys want to change it to 28, so you should be the one proving your way works better, no?

The 16 hour rule started in 2011, so we don't actually know that it has produced competent physicians.

 

[chipwhitley]

Actually not. The doctors that did their entire residencies under the 16 hour rule have, at best, been out for 2 years. The surgeons affected by the changes (since they are the ones likely most affected) have been out for a mere 5 months assuming no fellowships, so no we really don't know if the new process makes competent doctors.

Really the only thing we do know about the 2011 changes is that they don't seem to make a difference in patient results and resident satisfaction among surgeons: https://www.absurgery.org/default.jsp?news_trial0216

Then it would make sense to keep the 16 hour rule going until we have enough data to tell if it works, wouldn't it? Why are we rushing to change it when we don't know?

 

[VA Hopeful Dr]

Then it would make sense to keep the 16 hour rule going until we have enough data to tell if it works, wouldn't it? Why are we rushing to change it when we don't know?

Because we know the old way worked, and now we have decent evidence that the old way wasn't bad for patients or residents. If it turns out the new way is inferior, we'll have several years of inferior physicians.

That being said, I think even if they did go back to the old way that many programs would stay as is. Redoing the entire residency schedule is not a fun task and if a program is happy with the way things are they can stay that way. Rolling back to 2003 rules doesn't require interns to work 28 hour shifts, it just means they can.

Lots of places I interviewed/rotated it were doing night float systems as far back as 2007 anyway so I don't see them going back to overnight call for everyone.

 

[ProfMD]

Then it would make sense to keep the 16 hour rule going until we have enough data to tell if it works, wouldn't it? Why are we rushing to change it when we don't know?

Have you not read the other posts on this thread? Several of us have enumerated multiple reasons why walking back the changes made in 2011 makes sense.

 

[bannie22]

Exactly

It is the onus to prove that working >16 hours is superior before such a change can be made

In fact, in any other workplace the hours and pay itself would be illegal under labor laws. Its surprising this even remains a discussion

Comparing attending call to resident call is another joke. Attending call is a breeze, do they have nurses call them every 5mins about stable normotension? In addition, attendings actually make money while being on call. They actually opt in to make that cash and many actually opt out because they dont want to work that extra

But the truth is this health sacrificing occupation will not change for this current generation because of the obtuse and foolish prior generation. And I dont blame them because some of them folks were abused back in the days and they cannot fanthom the newer generation creating a sustaininable model for both education and mental and physical health
Unfortunately because of this, this generation will move on and when the time comes I can see how the majority of physicians will want the cake to be passed down to the next generation

Pilots fly dramatically less continuous hours and require more time off. Here we are insisting we should be at the level of the airline industry in terms of outcomes yet insisting at the same time that the frontline work as slave-hours in a field where human lives are arguably more precarious to each action

 

[VA Hopeful Dr]

Exactly

It is the onus to prove that working >16 hours is superior before such a change can be made

In fact, in any other workplace the hours and pay itself would be illegal under labor laws. Its surprising this even remains a discussion

Comparing attending call to resident call is another joke. Attending call is a breeze, do they have nurses call them every 5mins about stable normotension? In addition, attendings actually make money while being on call.

But the truth is this health sacrificing occupation will not change for this current generation because of the obtuse and foolish prior generation. And I dont blame them because some of them folks were abused back in the days and they cannot fanthom the newer generation creating a sustaininable model for both education and mental and physical health
Unfortunately because of this, this generation will move on and when the time comes I cant see how the majority of physicians will want the cake to be passed down to the next generation

Pilots fly dramatically less continuous hours and require more time off. Here we are insisting we should be at the level of the airline industry in terms of outcomes yet insisting at the same time that the frontline work as slaves in a field where human lives are arguably more precarious to each action

You didn't read any of the responses here, did you? Several of us pointed out why going back to the 2003 rules doesn't need to prove itself.

Attendings absolutely can get called as much as residents do. Only residents think otherwise because they insulate the academic attendings. If you don't have residents, who do you think the nurses call? And once again, even in 2003 residents had work hour restrictions - attendings do not.

No practicing physician compares us to the airline industry. Planes are mind-blowingly simple compared to the human body. We'll never get similar outcomes as the aviation industry, at least not without massive improvements in our understanding of the body.

The current model (and the 2003 model) in fact is sustainable. Old doctors do exist, and in fact even before the 2003 doctors lived longer than the average. http://www.ajpmonline.org/article/S0749-3797(00)00201-4/abstract?cc=y=

 

[ThoracicGuy]

Exactly

It is the onus to prove that working >16 hours is superior before such a change can be made

In fact, in any other workplace the hours and pay itself would be illegal under labor laws. Its surprising this even remains a discussion

Comparing attending call to resident call is another joke. Attending call is a breeze, do they have nurses call them every 5mins about stable normotension? In addition, attendings actually make money while being on call. They actually opt in to make that cash and many actually opt out because they dont want to work that extra

But the truth is this health sacrificing occupation will not change for this current generation because of the obtuse and foolish prior generation. And I dont blame them because some of them folks were abused back in the days and they cannot fanthom the newer generation creating a sustaininable model for both education and mental and physical health
Unfortunately because of this, this generation will move on and when the time comes I can see how the majority of physicians will want the cake to be passed down to the next generation

Pilots fly dramatically less continuous hours and require more time off. Here we are insisting we should be at the level of the airline industry in terms of outcomes yet insisting at the same time that the frontline work as slave-hours in a field where human lives are arguably more precarious to each action

So why not just change it to 12 hour days. The onus is to prove that 16 hour days are better!@)!!(!``11!!1

But then what do I know... I just have gone through the pre-80 hour rules, 80 hour rules, and the 16 hour intern rules while doing my training. I've seen the differences directly.

 

[akwho]

I want to know where people are finding these surgical programs that actually adhere to the 16 hour work day for interns? Mostly it seems to be used for bashing juniors over the head with by seniors that think they had it harder. I've directly worked at 4 different programs, and visited 16 others. The only one I know of out of the twenty that actually has an 80 hour work week is UCLA because they have no actual trauma.

 

[ProfMD]

I want to know where people are finding these surgical programs that actually adhere to the 16 hour work day for interns? Mostly it seems to be used for bashing juniors over the head with by seniors that think they had it harder. I've directly worked at 4 different programs, and visited 16 others. The only one I know of out of the twenty that actually has an 80 hour work week is UCLA because they have no actual trauma.

When I was a resident we kept to the rule. We did have the 10% extension but I can honestly say that, even as a chief, I kept to it. We were also a level I trauma center with decent volume.

They do exist.

 

[Winged Scapula]

Exactly

It is the onus to prove that working >16 hours is superior before such a change can be made

That's not how research works. You must show that a change is as good as if not better than the standard of care.

Comparing attending call to resident call is another joke. Attending call is a breeze, do they have nurses call them every 5mins about stable normotension?

They might especially without residents. I've been called about some ridiculous things but I would say that in general if you're being called every five minutes about normal findings, that's either a problem between you and the nursing staff or you're misunderstanding the meaning of the call.

In addition, attendings actually make money while being on call. They actually opt in to make that cash and many actually opt out because they dont want to work that extra

LOL -- where did you hear that?

While there are some employment paradigms where that is the case, the vast majority of surgeons who take call, especially if it's for their own patients in the post op period, are not paid for those. Do you really think that or are you just making up stuff (as is your habit)?

You guys need to stop with the whole trope that we're a bunch of bitter old people who simply want to punish the younger generation. Nothing could be further from the truth; we just want to see that a change makes you good enough to take care of us in our dotage.




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[Winged Scapula]

I want to know where people are finding these surgical programs that actually adhere to the 16 hour work day for interns? Mostly it seems to be used for bashing juniors over the head with by seniors that think they had it harder. I've directly worked at 4 different programs, and visited 16 others. The only one I know of out of the twenty that actually has an 80 hour work week is UCLA because they have no actual trauma.

We have a fair number of surgical residents here who state that while on occasion they may go over 80 hours in general the programs are pretty good about sticking to those rules. I think there are a lot more than you would imagine.


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[IlDestriero]

LOL -- where did you hear that?

While there are some employment paradigms where that is the case, the vast majority of surgeons who take call, especially if it's for their own patients in the post op period, are not paid for those. Do you really think that or are you just making up stuff (as is your habit)?

It's common for Anesthesiologists to get paid to take call. In fact giving call and late shifts away to the young and/or cash hungry is an easy way for me to improve my lifestyle without having to cut back to 80% with the disadvantages that come with that (20% less Vaca and bonus, etc.). I don't really know how any other specialties deal with call.


--
Il Destriero

 

[giantswing]

I would say that in general if you're being called every five minutes about normal findings, that's either a problem between you and the nursing staff or you're misunderstanding the meaning of the call.
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We have those; the worst is when there's two of them either on back to back shifts or at the same time. I've gotten paged twenty times in one night - I counted - to the same unit to tell me about a temp of 37.8, or to tell me the xray had been taken.

And guess what happens if you say, "don't call me about stuff like that?" they go crying to their nursing manager that you're being mean and unprofessional. I hate nurses.