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

[Winged Scapula]

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.

More worrisome is that they decide not to call you about important stuff in a passive aggressive way.


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[Winged Scapula]

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

Yes I understand that.

However The user I was responding to claims to be a surgical resident and was talking about surgeons.

As I noted there are definitely some employment paradigms where you get paid to take emergency department call but the vast majority of us to take call for our patients aren't paid.

There are a few specialties in which the hospitals will require you to take call as part of being on staff but my experience has been largely that in a community practice where there are other facilities the hospitals found that requiring call meant that they lost those specialist to other facilities.

Interestingly, I just got back from visiting a two physician couple who pay their nanny to be on call on nights when they're both on call; i've never really thought about that.


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[giantswing]

More worrisome is that they decide not to call you about important stuff in a passive aggressive way.


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Like when the patient desats after they give a benzo, an IV breakthru, and PO pain meds ALL AT THE SAME TIME. I've started writting "don't give with ECT." in my orders bc it's become a problem.

 

[cbrons]

Me and you, friend, have very different views on life and medicine. I don't think it's anybody's profession and nobody can claim it as their own. I don't think entitlement , as you call it, is a problem - I think it's a solution to a really ****ed up system steeped in non-sensical tradition and parochialism. Young docs need to raise up and break out of this idiocy and people like you are not helping. I think you misunderstood my comment, I'm not against government intervention - I'm for it (despite my picture). Fact that many people work 80 hours of week for paycheck to paycheck is not a reason we should aspire to the same, it's a reason why docs should be getting paid less and why there should be more equality in society. I have a feeling this will fall on (your ) deaf ears.

Are you a pre med like your status says? Your tone is cringeworthy and seems along the lines of the typical undergrad SJW.

 

[cbrons]

(As an aside, there are a lot of poor Americans for whom 80/hrs week is a way of life and no kind of ticket to a better one.)

Have to disagree with you on this one. You would be extremely hard-pressed to find someone in this country working menial jobs for 80 hours per week and barely scraping by. The welfare system here is extremely generous to the point where it is widely conned and taken advantage of, and often more profitable to not work minimum wage jobs. (Not that I blame those people for doing so btw).

 

[akwho]

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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I bet my attendings would say I work 80-hours a week as well, accompanied by the usual hand waving and talking about how much harder it used to be. Did you know it used to snow uphill both ways in the hospital before the 90's and global wussification? I've heard all about it.

But they don't know because they're not at the hospital at 4am or 9pm. I am. My hours are logged as 6am - 6pm everyday x6 days a week. Everyone I know does the same thing. I'm not complaining by the way, I choose a work hard program so I would get the volume I need to become an excellent surgeon. I stay late for procedures, surgeries and patient care, and I don't mind working long hours. I do mind smug attendings who think the hours restrictions means our training is inferior to theirs, when we don't adhere to them anyways.

 

[ProfMD]

I bet my attendings would say I work 80-hours a week as well, accompanied by the usual hand waving and talking about how much harder it used to be. Did you know it used to snow uphill both ways in the hospital before the 90's and global wussification? I've heard all about it.

But they don't know because they're not at the hospital at 4am or 9pm. I am. My hours are logged as 6am - 6pm everyday x6 days a week. Everyone I know does the same thing. I'm not complaining by the way, I choose a work hard program so I would get the volume I need to become an excellent surgeon. I stay late for procedures, surgeries and patient care, and I don't mind working long hours. I do mind smug attendings who think the hours restrictions means our training is inferior to theirs, when we don't adhere to them anyways.

Two things:

1) I am not sure who the "smug attendings" are. In case you are talking about any of us on this thread, I would say that many of us trained under the 80 hour rule, and none of us is advocating rolling it back. It is the 16-hour rule for interns and further restrictions on work hours that we object to.

2) While I can only speak from personal experience, I can say that I logged my hours faithfully as a resident and met the requirements. It actually was not that hard to do - mostly just took efficiency so I was not in the hospital late after cases finishing up notes, etc.

 

[Winged Scapula]

I bet my attendings would say I work 80-hours a week as well, accompanied by the usual hand waving and talking about how much harder it used to be. Did you know it used to snow uphill both ways in the hospital before the 90's and global wussification? I've heard all about it.

But they don't know because they're not at the hospital at 4am or 9pm. I am. My hours are logged as 6am - 6pm everyday x6 days a week. Everyone I know does the same thing. I'm not complaining by the way, I choose a work hard program so I would get the volume I need to become an excellent surgeon. I stay late for procedures, surgeries and patient care, and I don't mind working long hours. I do mind smug attendings who think the hours restrictions means our training is inferior to theirs, when we don't adhere to them anyways.

Apparently, you didn't read my post.

I said there were SURGICAL RESIDENTS on SDN who stated that their program was compliant.

I'm not sure why they would have any reason to lie given the relative anonymity.

Where you decided to make it about smug attendings says more about you than any one here. I never said one word about "inferior training".

 

[Jc2008]

Have to disagree with you on this one. You would be extremely hard-pressed to find someone in this country working menial jobs for 80 hours per week and barely scraping by. The welfare system here is extremely generous to the point where it is widely conned and taken advantage of, and often more profitable to not work minimum wage jobs. (Not that I blame those people for doing so btw).

Not a typical pre-med. I'm an attorney/MBA etc...I've had an unusual life to say the least. But honestly I don't agree with what you say about the welfare system (it was dismantled in 1995 by clinton's welfare reform) and I think if you read a little about it you may change your mind too (or maybe not). This is a good starter listen if you ever have time:

http://www.wnyc.org/story/breaking-news-consumers-handbook-poverty-america-edition

cheers

 

[thedrjojo]

Apparently, you didn't read my post.

I said there were SURGICAL RESIDENTS on SDN who stated that their program was compliant.

I'm not sure why they would have any reason to lie given the relative anonymity.

Where you decided to make it about smug attendings says more about you than any one here. I never said one word about "inferior training".

I'm one of those surgical residents who as an admin chief force my juniors to log the hours correctly. It caused major changes at one of our teaching sites.

I don't know anyone in my program or anyone I met on the interview trail for fellowship that wants the 16hrs to stay. Thank God my program has been in the first trial relaxed arm these last 3 years.

As a chief I hardly ever have post call days. I miss them dearly.

Interns never had a golden weekend in the 16hr Era. Days off would be a 36hr period between 6am Saturday and 6pm Sunday when on night float.

We had to pull interns from the sicu cause an intern coming in at 6pm that didn't know what was going on during the day wasn't safe to take care of the unit, which is one of the most educational and challenging intern rotation for us. Thus our pgy2's were now behind until their pgy2 sicu rotation, and they had to have 2 sicu rotations instead of a more operative rotation, thus they were behind when they were 3s operatively.

We still have night float. But now night float ends Friday 6am and starts back Sunday 8am, essentially giving you a 2 day weekend every weekend. An intern does a 24hr shift Friday, and a 24hr shift Saturday before Nf comes back for a 22hr shift Sunday.

And I don't know any real evidence that patient outcomes are worse during the call/post call period. . . Those studies look at doing menial tasks while sleep deprived, not focused tasks. I never feel tired while I'm active, it's once I get home and lie down that I pass out.

 

[Danbo1957]

I can tell you that intern hours will continue to be protected at "sane" levels in our IM program, of course we have 48 categorical interns each year.

I was one of those interns that worked those "36-hour days" of yore. We interns thought of ourselves as medicine apprentices with a "calling", and were basically content to be paid in food. We each had a lot of patients, many were indigent and really sick. We were given an incredible amount of autonomy concerning treatment, not seen today, and were the "darlings" of those nurses with whom we worked (what's a mid-level?). The resident training model changed in the 1980's to more of what is done today after CMS took over and standardized training. Advancements in drugs, therapies, and especially imaging have all made training easier, but at the cost of three year residencies to that of just the one year as was done as through the late 1970's. Learning the world of western medicine takes time; heck, diagnosis through pattern recognition takes the treatment of many patients to learn. There's no correct time frame of "hours worked", expect continual modification of number of hours as evidence of efficacy accrues.

 

[operaman]

The new hours changes worry me but for different reasons. The changes in language for logging hours on home call could have profound implications for residents at all levels. As it is we have arguably the most amazing call schedule with a ton of golden weekends, but the price of this schedule is that we occasionally put in some grueling calls. Personally I'd rather push through occasionally in exchange for a much better schedule overall. I hope the final language allows us eneough leeway to keep what we have.

Frankly, I think there are serious problems with trying to regulate this stuff at a national level. Every program and institution is different and would likely benefit from different sorts of scheduling. Maybe I'm just spoiled by having an awesome PD, but I think that most programs would try and do right by their residents. Personally I've learned a TON on long grueling calls. I always hope for a quiet night but in retrospect, I've grown significantly this year in large part from nights where everything seemed to be falling apart. As an intern I had 24+4 calls thanks to the trial, but these were invaluable to me in that I got to spend the day taking care of a really sick list alonside seniors and fellows and attendings, but then handle those same folks by myself at night. It was a great way to grow while having the confidence of having dealt with some badness during the day when I had more help.

 

[mimelim]

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

I don't think you know anything about taking call as an attending or a resident. The vast majority of physicians do not have residents or mid-levels to buffer between them floor calls. Granted, most practices don't take care of patients with a ton of overnight calls, but that is also true for many residency programs.

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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It all depends how you count. You can work 80 hours/week in my program and as long as you are somewhat of a team player and are willing to bend a little bit here and there nobody is going to be mad at you. But on the flip side, my typical weeks are 90-110 hours/week. We have weekly case conference, basic science, journal club presentations to prepare. It isn't atypical to spend 3-6 hours preparing one of those, depending on the complexity. Then there is the research which is not mandatory, but in an academic program, somewhat expected. Then there is everything else. I am on a GME committee. I am on the editorial board of a journal. etc etc. It isn't hard to get up there when all of that has to come after your direct clinical duties.

Now, I am currently on a rotation that I am on call 24/7 for 3 months straight. Granted, we are in a community hospital and there are few night emergencies, but we do 45-50 cases/month here. It is busy. Long hours, no intensivist, etc.

 

[Winged Scapula]

I don't think you know anything about taking call as an attending or a resident. The vast majority of physicians do not have residents or mid-levels to buffer between them floor calls. Granted, most practices don't take care of patients with a ton of overnight calls, but that is also true for many residency programs.





It all depends how you count. You can work 80 hours/week in my program and as long as you are somewhat of a team player and are willing to bend a little bit here and there nobody is going to be mad at you. But on the flip side, my typical weeks are 90-110 hours/week. We have weekly case conference, basic science, journal club presentations to prepare. It isn't atypical to spend 3-6 hours preparing one of those, depending on the complexity. Then there is the research which is not mandatory, but in an academic program, somewhat expected. Then there is everything else. I am on a GME committee. I am on the editorial board of a journal. etc etc. It isn't hard to get up there when all of that has to come after your direct clinical duties.

Now, I am currently on a rotation that I am on call 24/7 for 3 months straight. Granted, we are in a community hospital and there are few night emergencies, but we do 45-50 cases/month here. It is busy. Long hours, no intensivist, etc.

Clearly there are non-clinical duties which are counted and can eat up time. However I do not think it's fair for you to compare a busy vascular residency, with numerous non-operative requirements, to other programs.

Despite the belief here by our premed students, there are plenty of community surgery programs without trauma or other time intensive rotations which do keep under the 80 hours. As a matter of fact several of the other regular SDN surgical residents have posted that their programs are in compliance and some of those users are at major medical centers.

There are always exceptions of course and as a matter fact my longest straight stint in the hospital, three full days without going home, was on vascular but I don't think it's fair to represent this as the standard.


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[Psai]

Clearly there are non-clinical duties which are counted and can eat up time. However I do not think it's fair for you to compare a busy vascular residency, with numerous non-operative requirements, to other programs.

Despite the belief here by our premed students, there are plenty of community surgery programs without trauma or other time intensive rotations which do keep under the 80 hours. As a matter of fact several of the other regular SDN surgical residents have posted that their programs are in compliance and some of those users are at major medical centers.

There are always exceptions of course and as a matter fact my longest straight stint in the hospital, three full days without going home, was on vascular but I don't think it's fair to represent this as the standard.


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wtf 3 whole days? no sleep?

did u get to brush your teeth

 

[VA Hopeful Dr]

wtf 3 whole days? no sleep?

did u get to brush your teeth

I did that once too: 4 continuity OB patients one after another. Got to the hospital 6pm Wednesday , left noon Saturday.

 

[wxman393]

I'm wondering if the medical community could adopt the aviation approach to duty day restrictions.


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[Buzz Me]

wtf 3 whole days? no sleep?

did u get to brush your teeth

I've had a couple similar experiences, once in residency and once in fellowship. Went to work early Friday morning, didn't come home until late Sunday evening. Just quick power naps here and there during those weekends of hell.

 

[Dr.LeoSpaceman]

I'd just like to interject that I don't think the analogies to aviation fit. When in the hospital for 28 hours, not all 28 hours are spent completing thought-intensive activities. There is time for lunch/dinner, BS-ing with co-residents, staring at the wall, etc.

 

[ProfMD]

Aviation limits duty day and flight hours. Equivalent would be if a resident could have a total of 16 hours entering to leaving the hospital but is also limited by a separate hour limit for procedures.

What would the procedure limit be? If I have a 12 hour case, do I need to scrub out in the middle. That does not make for good patient care.

There are some things we can learn from the aviation industry (checklists), but other things (work hours) are not directly applicant for the simple reason that taking care of people is not the same as flying a plane.

 

[Winged Scapula]

wtf 3 whole days? no sleep?

did u get to brush your teeth

I don't recall how much sleep I got but there was some. My longest staying awake stint was 41 hours straight.

I'm fairly sure I got to brush my teeth at some point during those; maybe even a shower and change of socks and underwear.


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[wxman393]

What would the procedure limit be? If I have a 12 hour case, do I need to scrub out in the middle. That does not make for good patient care.

There are some things we can learn from the aviation industry (checklists), but other things (work hours) are not directly applicant for the simple reason that taking care of people is not the same as flying a plane.

Coming from the surgery side, does operating while fatigued pose unnecessary risk to the patient? I can only imagine that 12+ hour surgeries are incredibly taxing, both on the surgeon(s) and the OR team. Can you take breaks? Can you sit if the case allows?

I agree with using checklists. If properly implemented, they can save time and costly errors.

 

[ProfMD]

Coming from the surgery side, does operating while fatigued pose unnecessary risk to the patient? I can only imagine that 12+ hour surgeries are incredibly taxing, both on the surgeon(s) and the OR team. Can you take breaks? Can you sit if the case allows?

I agree with using checklists. If properly implemented, they can save time and costly errors.

It's interesting that the fatigue usually does not set in until after the case is over. Sometimes I feel amped up for an hour or two beyond that. Sympathetics in overdrive I suppose.

 

[Goro]

I don't recall how much sleep I got but there was some. My longest staying awake stint was 41 hours straight.

I'm fairly sure I got to brush my teeth at some point during those; maybe even a shower and change of socks and underwear.


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[alpinism]

Bunch of crybabies in this thread.

I mean its not like the old intern schedule was designed by a workaholic cocaine addicted surgeon who spent time in an insane asylum.

 

[ProfMD]

There are missions longer than 12 hours in the cockpit. Also, I may just be uninformed but how many residents are completing 12 hour surgeries across the US? This seems like an outlier of an example.

While flying and taking care of people aren't the same, I think the reasoning behind work hours is applicable: Excessive periods of work cause fatigue and mistakes.

That's what everyone says - fatigue causes mistakes. And while that is true in well controlled studies with neuropsychological testing, it doesn't come to fruition in the real world. Studies have clearly shown that limiting work hours has not improved patient safety.

The reasons for this are numerous. Part of it is that you introduce other errors with shorter work hours, largely related to handing off patients to other residents. There are probably other reasons as well. The real world is messier than the laboratory tests.

If restricting hours really improved patient safety, we would all support it. However, they do not. And, there is very real concern, at least among surgeons, that residents are not being adequately trained. In addition, studies of surgical residents have shown that they are less satisfied with the shorter work shifts.

 

[thedrjojo]

Coming from the surgery side, does operating while fatigued pose unnecessary risk to the patient? I can only imagine that 12+ hour surgeries are incredibly taxing, both on the surgeon(s) and the OR team. Can you take breaks? Can you sit if the case allows?

I agree with using checklists. If properly implemented, they can save time and costly errors.

You can and I often see my attendings do take an occasional break on Transplants for example (with 2 of them, there are natural points where one of them can scrub out and have the other continue with the resident, also natural points where the resident can scrub out).

But as others say, the adrenaline rush/concentration of a real surgery can't be replicated in any cognition test.

 

[MediCane2006]

I used to have an attending who would insist on breaks every 4 hours or so during long cases (like free flaps). I HATED it. It completely unsettled my concentration and focus, not to mention I always felt like we were dragging out the case unnecessarily.

 

[Perrotfish]

That's what everyone says - fatigue causes mistakes. And while that is true in well controlled studies with neuropsychological testing, it doesn't come to fruition in the real world. Studies have clearly shown that limiting work hours has not improved patient safety.

The reasons for this are numerous. Part of it is that you introduce other errors with shorter work hours, largely related to handing off patients to other residents. There are probably other reasons as well. The real world is messier than the laboratory tests.

If restricting hours really improved patient safety, we would all support it. However, they do not. And, there is very real concern, at least among surgeons, that residents are not being adequately trained. In addition, studies of surgical residents have shown that they are less satisfied with the shorter work shifts.

We have never restricted work hours. We have occasionally rearranged them. When the 80 hour work week was introduced, the average number of hours worked by residents was just under 80 hours. The new Intern year rules didn't even try to restrict work hours, they just restricted the number of hours worked in a row, so everyone who stopped having call days also stopped having post call days. And of course the ACGME never had any sort of enforcement mechanism or whistleblower protections for the work hours anyway, so most of us were at 90-100 hours/week (in hospital, not counting studying/presentations/research) continuously through intern year and then for 2/3 months as senior residents. Surgeons of course exploit the insane home call rules to push their hours well above 100/week continuously

The best way to estimate how many hours Residents actually work is the number of admissions and procedures that they do. Those number are carefully audited because they translate into money. And both of those numbers have gone UP since the original work hour rules were implemented. In fact a current resident can expect to admit nearly 50% more patients over a 3 year residency than a resident at the time the original work hour rules were implemented, even though admissions have generally become more complex and documentation requirements have become more onerous.

The reason the work hour rules didn't make anything better is that they didn't make anything better. If you want to see safety you would need to actually reduce the number of work hours, and you would need to have a mechanism to actually enforce the rule.

 

[ProfMD]

We have never restricted work hours. We have occasionally rearranged them. When the 80 hour work week was introduced, the average number of hours worked by residents was just under 80 hours. The new Intern year rules didn't even try to restrict work hours, they just restricted the number of hours worked in a row, so everyone who stopped having call days also stopped having post call days. And of course the ACGME never had any sort of enforcement mechanism or whistleblower protections for the work hours anyway, so most of us were at 90-100 hours/week (in hospital, not counting studying/presentations/research) continuously through intern year and then for 2/3 months as senior residents. Surgeons of course exploit the insane home call rules to push their hours well above 100/week continuously

The best way to estimate how many hours Residents actually work is the number of admissions and procedures that they do. Those number are carefully audited because they translate into money. And both of those numbers have gone UP since the original work hour rules were implemented. In fact a current resident can expect to admit nearly 50% more patients over a 3 year residency than a resident at the time the original work hour rules were implemented, even though admissions have generally become more complex and documentation requirements have become more onerous.

The reason the work hour rules didn't make anything better is that they didn't make anything better. If you want to see safety you would need to actually reduce the number of work hours, and you would need to have a mechanism to actually enforce the rule.

My posts have largely been about surgical training, which is where I have seen the most research and I have a vested interest.

Work hours for surgical resident absolutely went down. Safety did not improve. Quality of resident training suffered.

One of the points I, and others, have made is that you cannot hold all specialities to the same regulations. The training of each has different needs.

That being said, there are non-surgeons who also disagree with the 16-hour rule, but they can respond for themselves if interested.

 

[PL198]

We have never restricted work hours. We have occasionally rearranged them. When the 80 hour work week was introduced, the average number of hours worked by residents was just under 80 hours. The new Intern year rules didn't even try to restrict work hours, they just restricted the number of hours worked in a row, so everyone who stopped having call days also stopped having post call days. And of course the ACGME never had any sort of enforcement mechanism or whistleblower protections for the work hours anyway, so most of us were at 90-100 hours/week (in hospital, not counting studying/presentations/research) continuously through intern year and then for 2/3 months as senior residents. Surgeons of course exploit the insane home call rules to push their hours well above 100/week continuously

The best way to estimate how many hours Residents actually work is the number of admissions and procedures that they do. Those number are carefully audited because they translate into money. And both of those numbers have gone UP since the original work hour rules were implemented. In fact a current resident can expect to admit nearly 50% more patients over a 3 year residency than a resident at the time the original work hour rules were implemented, even though admissions have generally become more complex and documentation requirements have become more onerous.

The reason the work hour rules didn't make anything better is that they didn't make anything better. If you want to see safety you would need to actually reduce the number of work hours, and you would need to have a mechanism to actually enforce the rule.

This is why I think it's so funny when attendings try to talk about their training. It's just not comparable. patients were less sick, there were less patients, etc etc. 80 hours now is nothing like 80 hours 20 years ago.

 

[ProfMD]

This is why I think it's so funny when attendings try to talk about their training. It's just not comparable. patients were less sick, there were less patients, etc etc. 80 hours now is nothing like 80 hours 20 years ago.

True statement when you are referring to attendings to trained decades ago.

However, most of the attendings posting on this thread, many in favor of relaxing the 16-hour rule, have been in practice for no more than 5 years. Several of us also work in academia. Therefore, we have a pretty good idea of what training is like now and the workload is pretty comparable to what we went through.

 

[PL198]

True statement when you are referring to attendings to trained decades ago.

However, most of the attendings posting on this thread, many in favor of relaxing the 16-hour rule, have been in practice for no more than 5 years. Several of us also work in academia. Therefore, we have a pretty good idea of what training is like now and the workload is pretty comparable to what we went through.

the 50 % stat wouldn't agree with that. so are you disputing the stat? 50 % increase in admissions is a huge increase in work

 

[ProfMD]

the 50 % stat wouldn't agree with that. so are you disputing the stat? 50 % increase in admissions is a huge increase in work

I'd have to see the data, particularly broken down by speciality. From my n of 2 study (my residency and the one I work in now) I admitted and did more consults on call than the current residents do. I started training in 2003, the year the work hour restrictions first started.

For surgeons, though, the training is not so much about how many patients you admit as much as it is about how many surgeries you do. Surgeries have not gotten much faster in the last 10 years. Therefore, fewer hours means fewer surgeries which means less training.

 

[PL198]

I'd have to see the data, particularly broken down by speciality. From my n of 2 study (my residency and the one I work in now) I admitted and did more consults on call than the current residents do. I started training in 2003, the year the work hour restrictions first started.

For surgeons, though, the training is not so much about how many patients you admit as much as it is about how many surgeries you do. Surgeries have not gotten much faster in the last 10 years. Therefore, fewer hours means fewer surgeries which means less training.

higher volumes mean more surgeries and less downtime.

 

[ProfMD]

higher volumes mean more surgeries and less downtime.

Not true. Each person can only perform one case at a time. In the places I trained, there was not downtime, other than after hours when there were no elective cases. Even then it was hit or miss due to emergencies.

 

[VA Hopeful Dr]

This is why I think it's so funny when attendings try to talk about their training. It's just not comparable. patients were less sick, there were less patients, etc etc. 80 hours now is nothing like 80 hours 20 years ago.

I graduated residency in 2013, I'm not sure patient acuity has changed all that much in 3 years.

I also did half intern year with overnight call and half with the 16 hour rule so I think I'm quite qualified to comment

 

[PL198]

I graduated residency in 2013, I'm not sure patient acuity has changed all that much in 3 years.

I also did half intern year with overnight call and half with the 16 hour rule so I think I'm quite qualified to comment

my comment specifically said 20 years ago but if you want to feel good about yourself, be my guest

 

[VA Hopeful Dr]

my comment specifically said 20 years ago but if you want to feel good about yourself, be my guest

Right but you said specifically "This is why I think it's so funny when attendings try to talk about their training. It's just not comparable. patients were less sick, there were less patients, etc etc." and I'm saying that for many of us here that just isn't true. That being the case, what exactly is your point?

 

[ProfMD]

my comment specifically said 20 years ago but if you want to feel good about yourself, be my guest

When I pointed out that many of us supporting the rule change have been in practice <5 years, you came back with this:

the 50 % stat wouldn't agree with that. so are you disputing the stat? 50 % increase in admissions is a huge increase in work

So which is it? Five years ago or twenty years ago when patient loads were lighter and the hills not as steep?

 

[SouthernSurgeon]

Timely:

http://www.journalacs.org/article/S1072-7515(16)31591-5/abstract

Only 14% of surgery residents preferred the 2011 duty hours to the flexible hours.

 

[Cognovi]

Timely:

http://www.journalacs.org/article/S1072-7515(16)31591-5/abstract

Only 14% of surgery residents preferred the 2011 duty hours to the flexible hours.

Only ~1/3 surgery interns preferred extended hours.

Most don't GAF. Interesting.

 

[neusu]

Only ~1/3 surgery interns preferred extended hours.

Most don't GAF. Interesting.

If you're eating a **** sandwich either way, neither appear terribly appetizing.

 

[Psai]

Only ~1/3 surgery interns preferred extended hours.

Most don't GAF. Interesting.

I know you love pubs but the data is bs. Their hours didn't change nor did their workload so it really doesn't make a difference at all.

 

[Winged Scapula]

When I pointed out that many of us supporting the rule change have been in practice <5 years, you came back with this:



So which is it? Five years ago or twenty years ago when patient loads were lighter and the hills not as steep?

Don't bother.

Acuity and patient load hasn't changed in 20 hrs either. This whole business about "today's patients would have been dead 20 yrs ago" ignores the fact that the dead and dying are a lot of work.


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[Cognovi]

I know you love pubs but the data is bs. Their hours didn't change nor did their workload so it really doesn't make a difference at all.

I know you love your own opinions, but weekly hours and workload are not the sole determinants of schedule preference. 13h x 6 feels different from 26h x 3 in a given week.

 

[Psai]

I know you love your own opinions, but weekly hours and workload are not the sole determinants of schedule preference. 13h x 6 feels different from 26h x 3 in a given week.

I love my opinions? For sure but I've seen your twitter and heard about you. I don't just speak to hear myself speak.

Also I know what a 13 hours vs 30+ feel like thanks.

 

[HooliganSnail]

24 is doable, in the right situations. That fresh intern is key. The intern is the one who generally gets most of the pages, has to do a lot of the running to preview situations before sending the ones that actually require attention up the chain.

The ideal on a 24 hours shift is that if there is a chance to nap, the doctor will take it, so that a 24 hour shift might actually involve a critical hour or two of rest somewhere within it. On certain services at the right facilities, it might mean getting almost a full night's sleep in a call room, with maybe just an interruption or two. So a 24 hour shift is doable in those situations. Heck, 36 or 48 becomes doable if there are genuinely enough rest periods within them.

So, that is the issue with extending 24 hours to intern year. They are taking the person who is almost certainly guaranteed not to get a minute of rest, and whose clinical judgment is least developed to begin with, and making sure that they are maximally fatigued. This will make intern year more hell than it needs to be, and will harm patients. As you say above, there are ways to resolve the problems with 16 hour shifts other than expanding them to 24 (plus 4 extra.)

I hope everyone who cares about this takes a moment to provide their commentary to the ACGME.

Wrong. The intern is largely useless and is there to do my H/P's. The fresh intern just serves to irritate me more.

 

[Dires]

I know you love pubs but the data is bs. Their hours didn't change nor did their workload so it really doesn't make a difference at all.

Yeah every program I've been at reflects your position. All the residents log fake hours and work more than they are supposed to. If they log the actual hours the PD meets with them to discuss it.

The other side I have seen is that surgical residents want to work so they can operate more. I think there is a lot of pressure to learn as much as you can in 5 years.

 

[SunsFun]

While my question doesn't pertain directly to the specific hours shift requirements, I can't help but wonder what the posters here think about the adverse impact that residencies, especially in surgical training create.

I know some of the attendings here are fairly progressive on most things, yet, seem to be completely ok (or at least complacent) with a system that pretty much selects for a very specific group of people. To be more specific, a female with children/parents (especially if they don't speak English) will not be able to commit so many hours a week for several years simply due to family constraints and not because of laziness or weak work ethic. So should someone like that be essentially precluded from doing orthopedics residency even if they are qualified enough to get in and want to go into that?

I know this is a matter of public policy rather than what the doctors think, but I am curious to see how individuals 'content' with a system in place justify this?


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