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56 Hour Week Is Coming

Discussion in 'General Residency Issues' started by exPCM, 05.20.08.

  1. exPCM

    exPCM Removed

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    See link: http://www.ahrq.gov/news/sp120307.htm

    The AHRQ final report is due to come out in about 9 months. People I know who are involved in the process tell me that the recommendation will be to decrease the maximum hours from 80 to 56 per week. The unresolved issue apparently is whether the number of years of residency training will be lengthened and by how much (for example will IM be changed to a 4 yr. residency, etc.)
  2. jiy76

    jiy76 Where's The Booze?

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    I like the idea but not the lengthening of the residency. Its not like the extra year is needed to make up for the hours reduced. You are doing pretty much the same damn thing for 3 years in IM no need for a 4th
  3. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner

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    They'll have to figure out how to put less **** in the bag.
    For some places, this means the end of pre-rounding. Not a bad idea in my book.
  4. Flopotomist

    Flopotomist I love the Chicago USPS

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    (Caveat - medical student, not any higher on the chain...)

    It seems like it could be done if there is a shift towards treating residency as more of a learning experience than a means of extracting cheap labor.

    Is there REALLY value at the 70th hour of a week for learning? Of course not - zombies just don't learn well at that hour.

    Of course this will mean hospitals will have to hire more staff (possibly NP/PAs to do more of the "scut").

    Curious to see if the "grown ups" who know more agree.
  5. HMSBeagle

    HMSBeagle

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    One of the genuine worries for med students should be the length of residencies if this is really true. 8-10 years before you get to "work" is something to think about. I think if this goes through, a grace period should be available.
  6. 3dtp

    3dtp Senior Member

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    While you have a point, much of residency training is spent in non-productive endeavors. There are many things that a clerk, secretary or other lesser trained person can do and do well that residents do now. This is an inapropriate use of an expensive resource, undervalued by our present "training system." This will have to change.

    Concerning the 56 v. 80 hour work week. I support the concept of reasonable working conditions and adequate rest, nutrition and leisure/exercise time. I trained in period where the 80 hour rules were published but never enforced and was told "the rules are just guidelines, the needs of the hospital take priority..." 110 hour work weeks, Q3Q4 call was the rule and you might get 4 days off a month, if things worked out that way. Rational: we don't have enough residents to do it any other way. Horsehockey.

    I have worked 60-80 hours most of my life and I had a long and prosperous one before med school. I also took time off, exercised and did a variety of things and was still productive. The killer is chronic and acute on chronic sleep deprivation, lack of proper exercise and lack of time for rest. The difference is that with rare and unusual exceptions, I got 7-8 hours sleep per night, every night. The math is simple. 14 hours and 5-6 days/week will give you 84 hours. Or you can do it in 30 hour blocks with no sleep. One is rough, the other miserable and unhealthy.

    It is simply unfathomable that anyone in charge of medical education believes that sleep deprivation of residents is good for the quality of care, the patients, the resident or the educational process. We know better. Set a maximum time on continous duty and a minimum rest time between on duty times and I suspect we won't have to worry about a maximum hour rule. Make a resident's time increasingly expensive beyond a certain hours/day hours/week and you bet things would change. And quickly. Overtime wages add up in a hurry. I do not advocate timeclocks and treating residents as hourly workers, but the hospitals have abused residents for a long time in the guise of "medical education." It is high time it stops.
  7. MedGoatTX

    MedGoatTX

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    I swear to god, this happens, I'm either a) quitting or b) becoming a lab rat. All the research requirement in peds fellowships isn't looking so bad right now. At least there you're not being pushed out the door before the job is done just to meet some bureaucratic dip****'s arbitrary timetable.

    I could maybe see the argument for limiting overnight calls. Although people trying to get their bodies adjusted to coming on/off a night float are just as shot. But limiting total hours to 56 is simply idiotic. There is absolutely no way to get all the experience of actually being there when things happen in just, let's say, six nine-hour shifts a week. And, if this happens, to even consider the possibility of not extending the total length of residency is just beyond the pale.
  8. MedGoatTX

    MedGoatTX

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    So do wages for all the PA's/NP's/extra residents who will have to be hired, which is an aspect of this debate that seems to be ignored by those pushing for more gutting of educational time.
  9. secretwave101

    secretwave101 Senior Member

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    If they cut residency training hours by what will be close to 40% (right?), they absolutely will need to increase the years of training. I can see why the recommendations might pass - no resistance from hospitals bec. they get cheap labor longer.

    I spend close to half of my time doing non-patient care work anyway. Charting chief among them. If my training gets cut this much, I might as well just sit at a desk and chart for 3 years and then "graduate". I'll be well-exercised, well-slept, a finely balanced well-tuned machine...and totally ignorant of patient-centered medicine.

    I hate all the hours I work, but I don't see a better alternative.
  10. colbgw02

    colbgw02 Delightfully Tacky

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    Not to mention the extra medicare dollars to fund the extra years of residency that they'll tack on. And they will.

    I can't believe I'm saying this, but I think this is a horrible idea. I honestly hope that I'm through with my training if/when this ever gets implemented.
  11. Strength&Speed

    Strength&Speed Need more speed......

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    This should absolutely not increase IM training lengths. Its already plenty long. It would affect surgeons however, i would think. 56 is tough trying to get in those surgeries.

    As far as treating residency as cheap labor...it is, and there are ways of improving the learning experience. they will have to hire for affiliated staff to decrease the workloads.
  12. Faebinder

    Faebinder Slow Wave Smurf

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    The link doesn't show anything about 56 hours.... Are you sure it is 56 not 65?

    Frankly, I'm all for it. The average resident now carries way way more patients than the resident back in the days and yet the requirements for permanent license is higher than it was years ago.

    Work me less hours, give me my license and let me go moonlight for extra money. That way I dont cost the system for training me and at the same time I'm not sinking with that 40k per year salary. Heck, moonlighting is an excellent way of learning the ropes and I believe it produces better residents.
  13. exPCM

    exPCM Removed

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    Yes, it is 56 and not 65

    See links:
    http://healthcare411.ahrq.gov/transcript.aspx?id=573&type=seg
    http://www.eurofound.europa.eu/eiro/2004/04/feature/uk0404105f.htm
    The 56 hours is based on the work hour limits that are currently in place in the UK/Europe.
  14. doc20

    doc20

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  15. MeowMix

    MeowMix Explaining "Post-Call"

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    #1, I don't believe it will happen. The drop to 80 hrs has not been shown to improve pt outcomes, so why go lower?

    #2, the unanticipated consequences could look like this: hospitals decide it isn't worth their time and $ to run residency programs. For the same $, they might get NPs, PAs, CRNAs, and even attendings (on salary, working infinite hours) to do more work.

    #3 looks like what happened at our med school, according to a senior attending. Some years ago, the med students were tired of being scutted out, justifiably complained, and scut was outlawed. The unanticipated consequence was that the overworked intern/resident now no longer had anyone to help out with the scut, because the med students were supposed to be learning, not scutting. So the interns/residents had even less time for teaching. On almost all my rotations, med students were a useless appendage who just added to the residents' work and whose most useful function was talking to families and chasing down charts etc. The system where students scutted and in return got rewarded with teaching, was gone.

    The solution to excess work is this (IMHO): set up an efficient system that gets the work done without the stupid unnecessary admin work. Having worked in multiple other fields, I find medicine to be the most absolutely inefficient of all. For example, cut out pre-rounding and repeat rounding with different levels of staff, unless you are actually going to do some kind of quality bedside teaching. Set up efficient admit and discharge paperwork that does not require crap like the resident having to hand-write the pt's discharge med list. Have admin people available to chase down charts from OSH. Get EMRs that actually work and do not add unnecessary time to the MD's day. Allow the option of typing in your note instead of dictating. Have flawless IT systems and staff that work all the time. Set up standards for calling consults that specify what you need to know, do, and order before calling the consult.

    Just my naive perspective.
  16. Coastie

    Coastie Junior Member

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    Cutting down on "clinical hours" will only boost the DNP argument. After all, 3 years of IM residency with 56 hours a week versus DNP time...Not to mention the greater need for midlevels to fill the gap of residents because of time restrictions.

    Not good folks.
  17. Bart Clarridge

    Bart Clarridge

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    I agree with you FWIW. They seem to do fine with fewer hours in other countries. Abusing residents for years seems to be an inducement to greed in some people: the "I paid my dues" mentality.

    As for the people who think it's normal, you have to realize back in the days when "Giants walked the Earth" they did somewhere between jack and sh!t. I mean yeah, they lived there, but they were playing Rummy. The guys who had it hard were the residents in the mid 80's to early 00's. They worked the same hours as the old school, but actually had the technology available to do something.

    Hopefully, the work hour restrictions will cause the hospitals to become more efficient. As others here have pointed out, the medical system lags. I remember seeing how proud a hospital was of their bar-coded patient wristbands. I thought, "yeah, but the grocery store beat you to that technology by about 30 years..." It's a bit pathetic really.
  18. secretwave101

    secretwave101 Senior Member

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    Can't believe how much I'm loving every one of the points you made here. I started typing my H&P's (off a template, so it was faster) and then asked if I could quit verbally dictating them (since the chart ended up with TWO typed H&P's). Admin acted like I was asking for permission to plaster my body with fentanyl patches and do rounds naked. Got the major smack-down.

    So, since that all that crap you mentioned won't go away, if hours are shorter, patient care is what will suffer.
  19. Coastie

    Coastie Junior Member

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    :laugh::laugh:


    We need a major efficiency overhaul. Should allow for some nice entrepreneurial folks to make a bundle...
  20. Finding Chi

    Finding Chi

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    "Allow the option of typing in your note instead of dictating."


    Totally agree. One of the few things I've liked about CPRS at the VA.

    As far as decreasing work hours...
    I'm all for more sleep and less call, but not at the expense of extending training. Someday I have to start paying back those med school loans instead of watching the interest blossom like a springtime petunia! Reducing work hours through more efficient hospital management, improved IT and streamlined paperwork should be the (albeit lofty) goal.
  21. 3dtp

    3dtp Senior Member

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    I'd like to make it clear. I do not support an arbitrary limit on maximum hours be it 56 or 84 or whatever. I stayed long past the hour limit from time to time when I was scrubbed on an interesting and educational case. But this was at a program that followed the ACGME rules, to the letter, was extremely interested in the highest quality resident education and managed its program well. Residents were not used for clerical work and when a chief ordered me to pull 30 sets of films for a clinic in front of the attending, the chief got a royal chewing for not using appropriate clinical support staff for this purpose. (Natch, the chewing came back to bite me since it was my fault the chief used bad judgement). But, I didn't pull films that day or any day after that, which allowed me to concentrate on the consults/follow ups of the day and not waste an hour getting films. These are the kinds of things that hospitals are accustomed to wasting residency time on.

    Progress notes: every note has to have every detail written, even though lab values/vital signs are readily available in computers everywhere these days, yet residents in some specialties still write a page and a half note every day on stable patients. Why? If it's so important to paste values in the chart note, have the clerk print the lab values and vitals on sticky lables, paste 'em in a progress note for the resident/attending to review and write your note around that. More work for unit clerks/nurses? Yup, but it makes rounding much faster and more efficient, again freeing up time for more educationally productive endeavors. One thing that amazed me more than anything about the medicine services at some institutions: Many, many centuries ago, monks copied books by quill. We knew this was inefficient and invented the printing press and the xerox. Why are we still doing this in medicine? This is one of PandaBear's peeves, and I agree.

    Again, I have no problem with the present 80 hour or 88 hour week, if it can truely be justified. Other professionals do it. We can too, safely. But and this is a huge caveat, working consistent, regular, extremely extended shifts is unhealthy, not educational, and not wise. This is the problem with the hospital abuses of residency education for busy work/clerical work. An occasional unplanned 24 or even 30 hour stretch for unique circumstances is probably reasonable. But this should be an exception for exceptional circumstances: The simple fibroid hysterectomy that turns out to be cancer and a short surgery is now an all day event comes to mind. Or the nasal pharynx resection that is a scheduled all day (15 hour) case. These are the type educational experiences that warrant exceptions. Not admitting the tenth chest pain patient of the day.

    The problem is that some hospitals have not been willing to be reasonable. Then the unique learning opportunity becomes a scheduled service resulting in the mess we had before the ACGME was finally forced to self-police or face congressional action.

    Some institutions, have taken the 80 hour week and its philosophy to heart, worked diligently to build a reasonable schedule which does not require excessive fatigue and is highly humane. These are great places to do residency, even though the work is hard, and the hours are still long. What I have been told by program directors/chairs from those institutions is their residents peform better, learn more and are prospering.

    Others have viewed the 80/30 hour rule as a regulatory burden and have made few changes other than to bring things into nominal and "loose" compliance. Residents in these institutions fare less well. These are the institutions would be targetted by the AHRQ recommendations.

    For me, I'd be satisfied with having no particular cap, but mandating 10 hours per day rest, averaged over a 7 day period, with a maximum on duty time of say 18 hours. This would still leave at a minimum, 6 hours of rest, would allow over 90 hours if a particular educational situation demanded it, yet, would insure that residents got at least marginally adequate daily rest. Make it an 80 hour week, and the numbers change to 12 hours rest per day averaged over a 7 day period. Wait, isn't that what EM does now? And they didn't extend their residency!
  22. turquoiseblue

    turquoiseblue

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    I think it wouldn't be so bad..there are other countries promote this sort of lifestyle with residents..life would be less stressful...less mistakes....more time to read and learn...more healthy for the residents...better lifestyle, where you actually have a life..of course people want to get done with residency fast because it's trauma, but this way it won't be so traumatic and easier to get through so the longer time may not be noticed as much...what's another year when quality of life is good? Not to mention, when you go into private practice, it's nothing like residency anyways. Who needs a right of passage of torture again--med school was right of passage enough, or at least mine was. Or if they do want a passage rite, torture us in intern year and let the other 2 years be much easier.

    if medicare wants to spend more money, nice--as long as they don't cut down the # of spots....i approve.
    :D :thumbup:
  23. MedGoatTX

    MedGoatTX

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    One does not equal the other here. The time for focusing on book-learning is over when you hit residency. Use it as a supplement but that's not where the most important parts of your education come from.
  24. MeowMix

    MeowMix Explaining "Post-Call"

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    See, this is what I find astounding. The computer-savvy interns at a program I interviewed at (not your program) tried to get the Powers to allow this. Voted down by the senior attendings. You'd think they'd be happy to save the transcriptionists' fees.

    I agree that the VA EMR is superior, and is an astonishingly good piece of technology for a govt organization not exactly known for tech innovation.
  25. Acherona

    Acherona Senior Member

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    Let's say patient health isn't affected by sleep deprived interns. Fine. But what about MY health?!!! Why don't they do a study on that?? Isn't my health just as important (to me it is very important).

    I don't understand why medicine has zero respect for sleep when studies have shown over and over how important it is for healing. We are constantly waking up very sick people at all hours of the night to do H&Ps that can wait until the morning, or to round, or accidentally because there are 4 people in the room. It's not right! Can't we all just get some rest?

    In Europe the residents work less, and consequently they know less, so the attendings have to pick up the slack and stay overnight on call with the residents. Also everyone makes less money. There's no free lunch unfortunately.
  26. Tired

    Tired Still winning.

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    What is the relationship between the AHRQ and the ACGME? Do these recommendations carry any weight whatsoever?
  27. filter07

    filter07

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    You must go to school where I work.

    Here the medical students contribute almost nothing to the team. Frankly, they suck.
  28. exPCM

    exPCM Removed

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    The AHRQ is part of the federal government which provides the $$$ to fund residency positions.
    The ACGME is a private organization that accredits/rubber stamps residency programs.

    The golden rule is that "he who has the gold makes the rules"

    Basically, the federal government has the final say here and not the ACGME.
    The feds make the laws and the rules.
  29. Tired

    Tired Still winning.

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    I may get out of Ortho if they go to 56hrs. I'm not doing a 9 year residency.

    If they're going to force everyone to work like a bunch of p*****s, I might as well do something low stress like Derm.
  30. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner

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    Your attendings must actually teach then. Typically what I learn from mine is how much the other partners are out to get him/her, why they are better at their job than the others, and other useless info. Very little medical teaching is done. If I didn't read, I wouldn't know my *** from a hole in the ground. I also wouldn't know how often they are wrong, be it because medicine has changed or because they just never were right.
  31. Winged Scapula

    Winged Scapula Cougariffic! Administrator SDN Senior Moderator Lifetime Donor

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    If I may interject - let's stop comparing ourselves to European residents. While their workweek may be shorter, these hours are regularly violated, not reported and their residencies are much longer. Tired doesn't want to be a PGY 11 when he finishes Ortho (I knew one in Oz) and none of you do either. So if we can please stop the absurdity in assuming that you can work European hours and finish on an American timetable.

    I wholeheartedly agree that a lot of residency time is wasted (having spent a considerable amount of it myself in the rads file room as an intern pulling films for rounds) and there are creative ways to minimize such noneducational stuff but you also have to accept that being there less means you also may miss out on some stuff as well.
  32. HMSBeagle

    HMSBeagle

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    Jesus Christ at last someone with common sense. Thanks Dr.Cox for keeping it real. Lets see who wants to do a 9 year residency. If people like healthcare and residency so much in Europe, why not move there? I've heard they have good wine and food over there.
  33. PediBoneDoc

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    there is serious discussion about this decrease in hours. 80 to 56, i think is too big a jump to do at once, but it is doable.

    the data on the hour change negatively affects residency education and competence is all ready out there. the data in europe shows that residents graduating under the hours restrictions are negatively affecting surgical residency. this has been discussed by the american college of surgeons. it is a concern and will most likely require an increase in years of training.

    in europe, case numbers significantly decreased after 80 hours. if this change should occur, there will be an increase in cost of residents. with the IME funding for residents being decreased already, university and hospitals are not looking for increasing their cost for residents. this issue is more than just about hours.

    i personally think it is a bad idea.
  34. c5a

    c5a

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    if there was any time for the federal gov't to scoop up some extra cash from somewhere, it's not right now. you don't just cut 24 hours of labor / resident / week without significantly increasing the cost to the hospital. reducing a resident's salary is hardly possible, as we are working for peanuts already.

    possibly all residencies will require night floats, or some 16 - continuous work hour restriction, as the studies also show the most mistakes happen with the 30 hour shifts.
  35. Faebinder

    Faebinder Slow Wave Smurf

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    I think 80 hours is fair for surgery and likes. I think 65 is fair for IM and likes. The question is, will they abide by the rules. We still have many programs that tell their residents to put 80 hours on there when they are working a 100. This contributes to the cry of "We need to lower limits."
  36. spudbunny

    spudbunny New Member

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    It seems to me that a 56 hour rule would greatly benefit midlevels and rns - if residency is 56 hours per week that is far more manageable for people with families. Plus, I could see a lot more rns and midlevels willing to go to med school and do residency if they could moonlight. I realize that usually one can moonlight after the first year if you receive a medical license but they could start moonlighting immediately. Wondering what others think on this issue - especially with all the animosity over the DNP. A 56 hour residency may be the deciding factor between DNP and MD/DO for some
  37. Winged Scapula

    Winged Scapula Cougariffic! Administrator SDN Senior Moderator Lifetime Donor

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    Not sure it would work that way. Most nurses I know didn't go the MD/DO route because of family concerns but rather wanting to play a different role in medicine. I'm sure there are many who cite work hour/family concerns but the training is entirely different and those I know, prefer "caring for the patient" rather than "figuring out stuf" (real quotes).

    WOuld be interesting though to see if programs lift their ban on moonlighting (those that have it) with the extra reduction in work hours.
  38. Faebinder

    Faebinder Slow Wave Smurf

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    I wouldnt mind extended residency (i.e. takes 2 more years maybe) if:

    1) Hours were reduced.

    2) Moonlighting was formally allowed (that way you can make an income and pay some loans and actually survive).


    This will benefit primary care as we will see experienced residents working in urgent care centers and clinics. Fills up the space that the midlevels are trying to occupy.

    The other better option is for residency programs to consider hours about the limit to be "moonlighting within the institution". Don't pay for a midlevel.. pay the resident because he/she will be able to bill medicare as the care provider not as a resident. At that point you'll see residents more invested in their own program and way more happy to stick around.
  39. Tired

    Tired Still winning.

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    I think this is really common sense, and I get annoyed at how caught up everyone gets in the idea that you can sleep, read more, and somehow be a better surgeon by reducing your hours. It's bunk. Reading is no substitute for practical training.

    Fewer hours = fewer patients seen = fewer operative cases = poor surgeon

    Duh.

    There are a lot of specialties where 56hrs/wk is plenty of time to learn your field. Path, Derm, Rad Onc, big portions of Medicine and its subspecialties. Fine, let them work less, they'll still be fine. But surgery is different, and we all know it. This means longer residencies or lower-quality training. Neither is particularly palatable to me.

    I'll be out of the residency game for two years starting this July. By the time I come back, this issue should be settled. If we switch to the 56hr week, I'll be doing a lot of soul-searching about whether or not Ortho is still feasible.

    Personally, at this point I think I'd rather be an excellent Dermatologist than a sh*tty 'pod.
  40. DrDre311

    DrDre311 Makaveli

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    You can read all you want, but unless you're blessed with magic hands, the only way to make your hands work for you is to operate like crazy. Repetition is key for learning and improving technical skills. Surgery is different, and so are surgeons. I personally support the idea of creating a separate ACGSE if the 56 hour week comes to fruition.
  41. MR1

    MR1

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    Agree, there are alot of residencies where 56 hrs would work. Surgery is definitely not one of them, but neither is medicine. Yeah some of the subspecialities, ie Rheum, Endo, etc. But not the Medicine residency. As an intern except on my 3 consult mths, all wards were 70-75hrs/wk and the 2 ICU were 80-85.

    Someone on here onetime posted about their program's EMR being able to print daily progress notes with vitals and labs already on them. Something like that could cut 5-10 hrs/wk off. Having more/better social workers = maybe 5 hrs a week. Do those things and now maybe we could do better on hours and I would be all for that. I don't see how midlevels would help medicine much though.

    But just cutting hours without doing something else, I just don't see how it would work and I DON'T want to do more years for any reason!
  42. DrDawg

    DrDawg Member

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    There are a couple of studies out that show that post work hour restriction, there was no change in the number of cases performed, and one was actually done with orthopods. That said I think this is because most programs don't adhere to work hour restrictions.
  43. DrDawg

    DrDawg Member

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    Thats neat and all but why not do that study in residents, he did report a large difference in sleep derprived people. You become used to working 24-30hr shifts, much like a runner becomes used to running 26.2 miles
  44. swpm

    swpm Now with extra snarkiness

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    QFT. There's a reason why every year some "good" residents fail their boards. One can reasonably put on a good show of being a good resident (hard working, good attitude, on time, technically adept) without reading ... then cram in a panic the last couple months ... then maybe pass, maybe fail. I read more now as a resident than I did as an MS3 or MS4.

    Sorry, what? You want to reduce the hours you spend in Big Blocky Building #1 and extend residency for two years, a time when you get paid crap, delaying the day when you get paid like a respectable working adult ...

    ... for the singular purpose of being able to work more hours in Big Blocky Building #2, getting paid marginally-better-than-crap moonlighting wages.

    IOW, you want to work the same hours now for a bit more money, at the cost of delaying the attending salary payoff even longer.

    That's like Chewbacca-on-Endor level crazy talk.
  45. DrDre311

    DrDre311 Makaveli

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    Now that does not make any sense! People, I'm talkin' bout Chewbacca. Does that make any sense?
  46. lowbudget

    lowbudget Senior Member

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    This is all pomp and circumstance in the post-IOM "To err is to human" era.

    It won't happen because it won't work. Who's going to pick up the slack where the residents leave off? Mid-levels? Attendings? And who's going to pay for that? GME/Medicare/Title VII? At a time when they want to cut funding and overall expenditure because they project old people will suck Medicare dry? Please.

    You already have a manpower shortage. Now, there's going to be shortage of the people who are supposed to be there. Who's left to take care of these patients? 1 faculty attending for every 20 NP/PA students working under them? What a joke.

    Let's do this: Residents take home call with faculty back up. And the hospital gets pre-med undergrads to do night float.

    This would be an unfunded mandate. To err is to get what you paid for. It'll never happen.
  47. lowbudget

    lowbudget Senior Member

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    Effectively, deploying more unqualified doctors out into the community without supervision. And you still haven't addressed the work-hour/safety issue.

    If they're worried about safety, what they really need to do is double check some of these nursing school credentials... or require all "nurses" to get advanced degrees so they can start functioning at the level of a real nurse. Please. Oooo Lord. Help me help the patient.
  48. exPCM

    exPCM Removed

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    Some unfunded mandates in medicine off the top of my head:
    EMTALA (ask any ER doc about this)
    USMLE Step 2 Clinical Skills (glad I never had to do this, I graduated back when this was not required)
    Physicians required to pay for interpreters for office visits (the interpreter often costs the doctor more than the reimbursement for the office visit)
    80 Hour Residency Work Rule
    HIPAA

    By your logic the 80 hour work rule would never have gone into effect since it was an unfunded mandate.
  49. lowbudget

    lowbudget Senior Member

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    ... and a nice list of ideas that were never really thought through. I don't understand how these federal agencies can make a rule without ponying up the financial support and then leave it to the locals to figure out. I mean, what the crap?
  50. Miami_med

    Miami_med Moving Far Away Moderator Emeritus

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    The big thing in government used to be creating big expensive programs, but when the people became tax averse, they instead focused on mandates that evil "rich" people have to pay for. All doctors and residents and hospitals are obviously rich, so this should be no problem;)

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