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How will new work hours effect GS?

Discussion in 'Surgery and Surgical Subspecialties' started by Toadkiller Dog, 07.30.02.

  1. Toadkiller Dog

    Toadkiller Dog Senior Member

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    Just curious what peoples' thoughts are on this subject. Here at my school, the GS program has (finally) mandated that residents get one day off a week, every week. Ours is known as a pretty malignant program, though.

    What have your schools been doing? And what do you see (without getting too sensational) as the long term effects of cutting GS work hours down to an 80-hour work week?
  2. tussy

    tussy Senior Member

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    There is talk in my program of changing general surgery to a 6 year residency. I think i'd rather work harder for 5 years, or at least have that option.
  3. dr.evil

    dr.evil Senior Member

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    There are thoughts of a "night float", less call, and the 6 year program tussy mentioned. Also, PA's or Nurse Practitioners for discharge summaries, H&P's, and other paperwork have been mentioned.

    If you think about it, if you arrange 2 weekends off per month (i.e. one day off per week) then you only work 6 days per week. That's an average of 13 hours per day you can work and still be under 80. If your start rounds at 6am, you can leave everyday at 7pm and be within your quota. Of course call is not included in my example and we often take call 3 times per week which adds on another 11 hours per each call. So probably, we will be coming in a 6am and leaving at 5pm, taking call 1-2x per week and coming really close to 80 hours.

    All of the residents have been talking about it and we just don't see how surgery can get to 80 hours per week and still be covered at night without the night float (which none of us want). Hours during the day don't hurt you but the call nights add up the hours.

    Although we're all proponents of keeping the residency from killing us, most do not feel that the 80 hour work week is necessarily good for the program or continuity of patient care. But we'll adjust. Sleep is good though.
  4. tussy

    tussy Senior Member

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    Ok, i'm still having trouble understanding what this night float thing that has been mentioned on multiple threads. When i'm on call for GS, I cover both my patients on the floor as well as those of the other 2 gen surg teams, also cover the thoracic surg floor, vasc surg floor, including 2 stepdown units, and take consults in the ER and am on the trauma team. It makes for a busy night of call, but i only do call every 4th night and ever other weekend and i have 2 clerks to help as well as a senior on home call for backup. This is the way it's always been here "up north". Is that what "night float" is, or is it something altogether different.
  5. neutropeniaboy

    neutropeniaboy Blasted ENT Attending

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    Tussy-

    The short of it is "no"; that's not what a night float it. A night float is a resident who comes in at 5pm (or whatever established hour), takes night call every night, signs out at 6am (or whatever) and leaves until that night when s/he takes night call again.

    At my former medical school, the medicine residency had a night float system and it was a 2-week rotation. The surgery program is trying it out this year.

    I'm lukewarm on the whole idea of night float. Only because during that time, you're not really getting any surgical experience. The idea that if you're not on night call (i.e., when you're not the night float) you won't get to experience the full range of patient problems and be able to work-up patients at all hours is bull****. Everyone will do night float (if it exists).

    Personally, I'd rather take call rather than have every evening blown for 2-4 weeks straight and have my sleep phase shifted for the first week during night float and then after night float is over.

    --

    My two cents on the whole 80 hour week thing is that it's difficult to accomplish. We're not shift workers -- that is, unless you're ER or anesthesia. You should go home when your work is complete, and that requires extension beyond a set number of daily hours.

    Personally, I don't have a problem working 100+ hours per week. My only gripe is that I should be PAID something respectable for what I do and for how long I do it.
  6. tussy

    tussy Senior Member

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    Hmmm, so you don't do any call, but then do 2 weeks of straight call with no day shifts. Interesting. That would be a hellish 2 weeks of straight call, but the reward would be no call for the next month.

    I agree; I don't mind working the odd 100+ work week, but i also think we deserve to be better compensated for it. So far here in Canada there is no legislation that dictates work hours for residents. We are limited by our housestaff association's contract (different at each university) that says no more than 1 in 4 call and no more than 30 hours straight. It not always firmly adhered to, but it starting to be.

    I look forward to hearing about other possible solutions.
  7. edmadison

    edmadison 1K Member

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    I agree that it will be very difficult to get down to 80 hours, but I think it is still a good idea. Residents may be able to work 100+ hours per week, but I don't want them anywhere near me or my family when they're chronically sleep deprived.

    Residents should get more money AND an 80 hour work week.

    Ed
  8. njbmd

    njbmd Guest Moderator Emeritus

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    Hi Folks,
    I usually start the day by pre-rounding at 0500h. We generally do work rounds at 0600h-0700h depending on the number of patients on service. After work rounds, we generally get orders in for the day and head off to OR or to the clinics, again depending on the service. Transplant, general surgery and vascular tend to have more patients and thus more morning work.

    If you are lucky, you may get to grab a bite to eat around noon but you might have to get something to drink and back into the OR or clinic until about 1500h-1600h. After the OR or clinic is done,(clinic can last until 1700-1800h) or you can do a heavy case such as a retroperitoneal resection or hepatic resection in the OR that lasts into the evening. You generally have will spend a couple of hours doing evening chores such as checking in on your sickest patients. Evening rounds can last until 1900h if you are fortunate. If you are on call, you try to get some dinner and some rest because you are going to be called most of the night for consults and putting out fires on the wards.

    Typical consults may be insertion of chest tubes and lines or seeing patients who are going to be admitted from the emergency room. You may also have a surgery or two to get done on patients who come in through the ER. Traumas are covered by the trauma service which has its own hours. If there are more than one trauma, the house coverage may be assisting with traumas too.

    On a good call night, you may get three to four hours of sleep. To have a good night, you should get good signout from your colleages who have covered their patients well so you are not doing things like writing sleeping pill orders. I always do a recon walk through the ward a little after nurse shift change to head off any calls for clarification of orders.

    You try to get some sleep, shower and go onto the next day. In my program, you don't go home after call but leave after evening rounds on the day that you are post call. You may still have to be in the OR or in the clinic on the day that you are post call. I am surprised at how easy it was for me to get used to this schedule. I spend far more than 120 hours in the hospital counting call.

    I won't kid you, you need to be in pretty good physical condition to maintain this schedule. You also need to eat well (avoid the junk) and work out when you can. I have even found plenty of time to read and study especially on call nights. I don't watch TV and I don't spend lots of time hanging out with the gang anymore. That's the essence of being a junior resident on general surgery.

    What will the new hours mean in terms of my schedule? Probably not too much. These new regs mean that I am responsible for reporting my hours which will cut into my reading and study time. Personally, I don't think things will change very much. I didn't enter General Surgery to be pampered; I entered this program to be trained. My training has been excellent and I have a program director who has made my life here at the hospital very nice. I am not doing scut, I am doing things that only a physician can do. My paperwork is minimal and my OR time is great!

    njbmd
  9. droliver

    droliver Moderator Emeritus

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    njbmd,

    I hope for your sake that the service you're on is not stereotypical @ your institution for your tenure. I expect that you hours in house will taper off signifigantly as you progress. As it stands, it sounds like your program will have signifigant growing pains (as we have) adjusting to the mandatory (and apparently strictly enforced) 80 hr weeks that the ACGME is going to require in July 2003. I suspect that by next summer there will be substancial changes in the way your rotations are scheduled & staffed.

    cheers

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