Neurosurg. Residents dislike work restrictions.

[tiedyeddog]

http://www.medscape.com/viewarticle/756953

This is something we already knew. From the Article:

"Among the new rules was a stipulation of a 16-hour shift limitation for postgraduate year 1 residents. As many as 83% of the survey respondents said they disagreed with the new rule, a sentiment that has been voiced in previous surveys."

"The concern is that this continuity of care for patients is compromised, as is essential training time, when residents need to adhere to restrictions on the duration of their shifts, said lead author Kyle M. Fargen, MD, MPH, from the University of Florida Department of Neurosurgery in Gainesville.

"Neurosurgery residents must care for large numbers of patients, many of whom are critically ill, and must learn to operate in long, complex cases from start to finish," he told Medscape Medical News.

"Most residents barely make it under the 80-hour limit on a week-to-week basis. Frequently, residents are forced away from important experiences, like finishing a surgery, addressing their patient needs, or other educational patient encounters, so that they stay under 80 hours for the week."

Interestingly, the strong opposition to the new rules was voiced despite the fact that 31 residents (8%) reported being involved in a motor vehicle collision or life-threatening event, and 20 (6%) reported having made a medical error resulting in patient harm after an extended shift."

tl;dr: they hate the 16 hour intern limit, they think the restrictions are hurting continuity of care, however, car accidents have occurred after long shifts.

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[Shnurek]

If I was in their position and wished to do more than the 80 hours I'd work the 80 hours and then say I am volunteering for any extra hours. Find legal loopholes if you wish.

 

[JacobMcCandles]

If I was in their position and wished to do more than the 80 hours I'd work the 80 hours and then say I am volunteering for any extra hours. Find legal loopholes if you wish.

You can't do what they do in the hospital as a 'volunteer'. I'm sure you could hang out and 'observe' but you'd better make damn sure your name isn't on anything.

 

[thomprya]

If I was in their position....wait, I would never be in that position. That sounds awful. Truly awful.

 

[kautionwirez]

neurosurgs are badass, they need those hours to train.

 

[Bartemius]

neurosurgs are badass, they need those hours to train.

 

[todds]

Actually almost all interns I've spoken with hate the new restrictions. They're actually MORE tired than they used to be on normal call schedules and find that it takes more of a toll on their body.

Top that off with lack of continuity of care - handoffs usually suck and the person who actually knows the story (who did the HPI or rounded on the patient in the morning) is the best person to cover for the patient but of course they aren't there.

To top it off, you feel like you're in the hospital longer. The new rules do suck for everyone, I would imagine even more so for neurosurgeons. Many won't appreciate this until they actually go through the process, I know I didn't.

They need to go back to 28 hours shifts. You're off strictly after you round the next morning - and if there is a concern for car accidents, for the love of god just go to the call room and take a nap before you actually go home, thats what I did on 28 hour calls.

 

[Rothbard]

nm

 

[GoSpursGo]

Actually almost all interns I've spoken with hate the new restrictions. They're actually MORE tired than they used to be on normal call schedules and find that it takes more of a toll on their body.

Most of the medicine residents I spoke with felt this way too. At least they used to have their post-call day to recover and decompress from the stress of being in the hospital; if they were lucky, a couple of the hours on those 28 hour calls could even be spent sleeping. Now, it just never ends.

Is it better for patient (and pedestrian) safety? Beats me. Just passing along the sentiments I've heard.

 

[Valadi]

For sure, the new rules blow. I would take pulling an all-nighter q4 and getting a post-call day over a 16 hour grind 7 days a week every time.

 

[kitsunepixie]

In general my program has always respected duty hours as much as possible because we're so team-based rather than hierarchical, but we do have some services that are more demanding than others and it's very difficult to be duty hour compliant on those rotations. The attendings on those services get chewed out and are threatened to lose residents all together if we struggle to stay duty hour compliant while on their service, so we get booted out of the OR when "time's up." That really sucks, since some of the best cases and best attendings to work with are on those particular services! Moreover, attendings are having to work much longer hours now to pick up where we residents left off...so we get to look forward to our lives being even more hectic when we are finally in their shoes. We've tried to decrease call by hiring more PAs/NPs, but they don't exactly grow on trees. We're also having to "dump" more "to do" lists on the on call cross-covering person rather than just sticking around and taking care of it ourselves, but I guess some days that is worse than others...

 

[neusu]

In general my program has always respected duty hours as much as possible because we're so team-based rather than hierarchical, but we do have some services that are more demanding than others and it's very difficult to be duty hour compliant on those rotations. The attendings on those services get chewed out and are threatened to lose residents all together if we struggle to stay duty hour compliant while on their service, so we get booted out of the OR when "time's up." That really sucks, since some of the best cases and best attendings to work with are on those particular services! Moreover, attendings are having to work much longer hours now to pick up where we residents left off...so we get to look forward to our lives being even more hectic when we are finally in their shoes. We've tried to decrease call by hiring more PAs/NPs, but they don't exactly grow on trees. We're also having to "dump" more "to do" lists on the on call cross-covering person rather than just sticking around and taking care of it ourselves, but I guess some days that is worse than others...

I hate having to scrub out of cases post call.

We manage pretty well with duty hours limits at the moment but more stuff is signed out than before. I, personally, prefer the 28 hour calls but q2 or q3 as a junior was pretty damn rough.

 

[armybound]

Gunners.

 

[ArcGurren]

Actually almost all interns I've spoken with hate the new restrictions. They're actually MORE tired than they used to be on normal call schedules and find that it takes more of a toll on their body.

Top that off with lack of continuity of care - handoffs usually suck and the person who actually knows the story (who did the HPI or rounded on the patient in the morning) is the best person to cover for the patient but of course they aren't there.

To top it off, you feel like you're in the hospital longer. The new rules do suck for everyone, I would imagine even more so for neurosurgeons. Many won't appreciate this until they actually go through the process, I know I didn't.

They need to go back to 28 hours shifts. You're off strictly after you round the next morning - and if there is a concern for car accidents, for the love of god just go to the call room and take a nap before you actually go home, thats what I did on 28 hour calls.

I agree - I didn't like getting in at 4:30 - 5 am on my surgery rotation but if I were to get in at 6:30-7 am as a medicine intern and leave around 7-9 am the following day on call after rounding with the attending or the other interns in the morning, I really wouldn't mind since I'd get the day off to rest/sleep/have fun/be with my fam. On the other hand, I know interns who've gone through two straight months of night float, and that sounds like utter torture.

I can definitely see the benefit of the work hour restrictions in terms of people getting more sleep and whatnot though.

 

[Instatewaiter]

I agree - I didn't like getting in at 4:30 - 5 am on my surgery rotation but if I were to get in at 6:30-7 am as a medicine intern and leave around 7-9 am the following day on call after rounding with the attending or the other interns in the morning, I really wouldn't mind since I'd get the day off to rest/sleep/have fun/be with my fam. On the other hand, I know interns who've gone through two straight months of night float, and that sounds like utter torture.

I can definitely see the benefit of the work hour restrictions in terms of people getting more sleep and whatnot though.

Hopkins will soon publish a study that shows the "extra" amount of sleep with the new system is basically neglibile.

The new system was pushed on all residencies without any evidence whatsoever. The ACGME should be ashamed of themselves for such unevidenced based practices. What a joke.

 

[todds]

In reality, they should go back to the old system - however mandate that residents be off by 10 am at the latest and mandate that hospitals have adequate quiet rooms where residents can take naps prior to driving home.

Coming in at 6am, leaving by 9pm on the long day and being back by 6 am the next day for weeks on end or two weeks sucks plain and simple for both residents and patients

 

[Valadi]

Hopkins will soon publish a study that shows the "extra" amount of sleep with the new system is basically neglibile.

The new system was pushed on all residencies without any evidence whatsoever. The ACGME should be ashamed of themselves for such unevidenced based practices. What a joke.

Really? Can you say what journal they're thinking of putting it on/who's going to be on it so I can keep an eye out? Thanks!

 

[Law2Doc]

If I was in their position and wished to do more than the 80 hours I'd work the 80 hours and then say I am volunteering for any extra hours. Find legal loopholes if you wish.

There are no such legal loopholes. You need to leave or the program runs the risk of penalties. You can't volunteer, or stay on in your own time. The reason being that if that was an option, some residency program somewhere would browbeat it's residents into "volunteering" regularly, and the duty hours would be meaningless.

Truth of the matter is that in many fields, not just NS, you are going to start to realize later in residency that you aren't going to have seen enough of everything and done enough of everything to be proficient at your specialty. Duty hours sound great, in the abstract, but sometimes it stands in the way of your training, rather than protects you from anything. So you will really start to resent duty hours that stand in the way of the cool case that shows up at the end of your shift. Yes, you want to go home, but there will be times when you feel it would be in your interest not to. And yet you don't have that choice.

 

[Shnurek]

Yes, you want to go home, but there will be times when you feel it would be in your interest not to. And yet you don't have that choice.

'Tis a shame. Maybe there should be an option to personally opt out of the restriction? Leave the choice to the resident and not the residency programs.

 

[Dr Love]

Hopkins will soon publish a study that shows the "extra" amount of sleep with the new system is basically neglibile.

The new system was pushed on all residencies without any evidence whatsoever. The ACGME should be ashamed of themselves for such unevidenced based practices. What a joke.

 

[Valadi]

'Tis a shame. Maybe there should be an option to personally opt out of the restriction? Leave the choice to the resident and not the residency programs.

That's impossible in medical culture. As pointed out, everyone would be brow-beating into 'peronally opting out.' And you would quickly become the black sheep of your residency program when the remaining residents are taking call, but you're at home sleeping because you didn't feel like 'opting out.'

 

[neusu]

That's impossible in medical culture. As pointed out, everyone would be brow-beating into 'peronally opting out.' And you would quickly become the black sheep of your residency program when the remaining residents are taking call, but you're at home sleeping because you didn't feel like 'opting out.'

For what its worth we're duty hours compliant. Like the op said, you're the black sheep if you're not. The chief is responsible if the duty hours are not followed. Cry as the juniors might, there aren't loop holes to staying after 28 hours or 88/week (with the exemption ).

 

[Charles_Carmichael]

Why does the ACGME enforce these rules if evidence doesn't support it (regarding patient safety, I mean)? I'm guessing it's due to pressure from Congress or something along those lines? It seems like a lot of the literature looking at mistakes/mortality after the rules were enforced has found no change or an increase in errors (presumably due to increased hand-offs).

So I'm not understanding why there has been another change implemented (the new 16 hr thing, I mean) without any supporting evidence or research to suggest it's a good idea.

 

[45408]

Interestingly, the strong opposition to the new rules was voiced despite the fact that 31 residents (8%) reported being involved in a motor vehicle collision or life-threatening event, and 20 (6%) reported having made a medical error resulting in patient harm after an extended shift."

tl;dr: they hate the 16 hour intern limit, they think the restrictions are hurting continuity of care, however, car accidents have occurred after long shifts.

And how many of them got in car crashes when driving after a regular shift? Or on a day off? Correlation/causation? That's like citing the number of 90-year olds who die within a week of getting a flu shot. Some of them were going to die anyway.

Double ditto for the medical errors. I've made medical errors on a day when I'm well-rested and fresh.

 

[tiedyeddog]

And how many of them got in car crashes when driving after a regular shift? Or on a day off? Correlation/causation? That's like citing the number of 90-year olds who die within a week of getting a flu shot. Some of them were going to die anyway.

Double ditto for the medical errors. I've made medical errors on a day when I'm well-rested and fresh.

I'm hoping the hopkins paper addresses this, I think it would really show the problem; we are humans and not machines. We make errors and that has to be acceptable, no matter if we slept a full 8 hours or 1.5.

 

[Law2Doc]

...

Double ditto for the medical errors. I've made medical errors on a day when I'm well-rested and fresh.

absolutely. I think I probably do more double-checking at the end of long shifts when I objectively feel tired than I do when I'm fresh. So I'd bet I'm actually safer to my patients at the end of a long shift.

 

[Law2Doc]

Why does the ACGME enforce these rules if evidence doesn't support it (regarding patient safety, I mean)? I'm guessing it's due to pressure from Congress or something along those lines? It seems like a lot of the literature looking at mistakes/mortality after the rules were enforced has found no change or an increase in errors (presumably due to increased hand-offs).

So I'm not understanding why there has been another change implemented (the new 16 hr thing, I mean) without any supporting evidence or research to suggest it's a good idea.

Simple -- this has never had anything to do with evidence. The initial change in rules came after media pressure in the wake of the Libby Zion case in NY, which likely wasn't really a case about a tired resident, but got a lot of coverage because the father was a NY columnist. Everybody took for granted that tired doctors were a bad thing, and the rules got changed. No useful studies were done before the change, and the claims haven't really been validated since -- error rates haven't gone down since the change. It's all based on something that seems intuitive, that a tired resident is a careless resident, yet the science demonstrating this is lacking.

 

[45408]

Simple -- this has never had anything to do with evidence. The initial change in rules came after media pressure in the wake of the Libby Zion case in NY, which likely wasn't really a case about a tired resident, but got a lot of coverage because the father was a NY columnist. Everybody took for granted that tired doctors were a bad thing, and the rules got changed. No useful studies were done before the change, and the claims haven't really been validated since -- error rates haven't gone down since the change. It's all based on something that seems intuitive, that a tired resident is a careless resident, yet the science demonstrating this is lacking.

I think some work hour restrictions were important, because putting someone on Q2 and keeping them until 8pm on their "post call" day and then repeating it the next morning, ad nauseum for a 5-7 year surgical residency is just inhumane.

But 16 hour shifts? Really? If you start at 6am, then you're "done" at 10pm. I can think of plenty of private practice or academic surgeons who have to do a lot more than that in a pinch.

 

[Law2Doc]

I think some work hour restrictions were important, because putting someone on Q2 and keeping them until 8pm on their "post call" day and then repeating it the next morning, ad nauseum for a 5-7 year surgical residency is just inhumane...

I think my point is you do the study first, and then make the change, not make a series of changes hoping the studies bear them out. So if you show people make a lot of errors working 100 hours, and fewer at 95, but then it plateaus at 80, then with a straight face you can cut it to 80. And then you look at the 30 hour shift and see where it plateaus, and the plateau is probably around 24+ hours, and so you cut it to that. But to make changes without any basis, and force fields like neurosurg to forego important training opportunities because the public thinks theyd rather have a well rested doctor instead of a better trained doctor seems pretty unreasonable.

 

[turkeyjerky]

absolutely. I think I probably do more double-checking at the end of long shifts when I objectively feel tired than I do when I'm fresh. So I'd bet I'm actually safer to my patients at the end of a long shift.

Yeah, I bet you're also less likely to make mistakes when you're drunk too, right?

 

[High Roller]

absolutely. I think I probably do more double-checking at the end of long shifts when I objectively feel tired than I do when I'm fresh. So I'd bet I'm actually safer to my patients at the end of a long shift.

I can understand the argument that work hour restrictions deprive residents of training opportunities, but what you're saying is completely absurd.

 

[kautionwirez]

Just throwing this out there:

Gawande wrote articles about fallibility and how to reduce human errors using a checklist, all collected into a book called The Checklist Manifesto.

The government should work with hospitals to improve catching such errors and lower the restrictions on residency hours.

Also, sometimes I work as well as I do when I'm exhausted.

edit:

I thought it was pretty cool seeing the surgical checklist being used in the OR while observing a PTE.

 

[Bartemius]

i can understand the argument that work hour restrictions deprive residents of training opportunities, but what you're saying is completely absurd.

you dare question a resident???!!!

 

[FrickenhugeMD]

this thread cracks me up, on more than one level

 

[Instatewaiter]

Just throwing this out there:

Gawande wrote articles about fallibility and how to reduce human errors using a checklist, all collected into a book called The Checklist Manifesto.

The government should work with hospitals to improve catching such errors and lower the restrictions on residency hours.

Also, sometimes I work as well as I do when I'm exhausted.

edit:

I thought it was pretty cool seeing the surgical checklist being used in the OR while observing a PTE.

There already is an organization that works on "catching errors" and improving standards in a hospital and it's called JCAHO. It create ridiculous amounts of red tap and hoards of mindless bureaucrats with nothing better to do than enforce this mindless dribble. The stuff that comes from JCAHO and actually makes sense is so mind-numbingly obvious you'd have to be an idiot not to realize it. The other stuff complicates your tasks so much and actually makes patient care more difficult and it makes the hospital jump through near impossible hoops.

Also most hospitals have their own safety board that does stuff at the local level (and this usually makes a lot more sense).

Checklists are good and bad. The checklists are supposed to take human error out of the equation and what they do is take thinking out of the equation. What actually happens is when someone does the "time-out" in the OR or such, everyone else just tunes out. Where I came from, they claimed that the errors in the OR actually increased when time-outs were initiated.

Similarly, based on many of these same ideas (and often forced by JCAHO) are nursing protocols. These too take the thought out of the equation. Try going up against one of these and the nurses will foam at the mouths. For instance, recently we had a patient who HAD to have an ICU bed (and a MICU bed was ideal). There was a single ICU bed in the hospital that happened to be in the MICU (perfect right?). But, the MICU already had 2 patients with the same last name and the nursing protocol said you can have only 2 patients on a unit with the same last name. They were considering swapping a patient with the surgical ICU (we give you a patient, you give us a patient) so we could take this patient. So 2 new patients at once to the MICU, one new patient to the SICU and for 2 out of the 3 the doctors and nursing staff are not equipped to take care of... that makes sense. Well the attending stepped in and put the kibosh on that but it was basically a knock-down drag-out war until he got his way.

The hour restrictions were not evidence based and honestly I doubt anything will ever make them go back. The same uproar happened when the 80 hour rules went into effect and nothing came of it. Unless there is insurmountable evidence that they damage patient safety, there's no going back. Even if evidence comes out that they don't improve patient safety and the 30 hour calls were just as good, ACGME is not going to reverse its decision... or at least I would be very, very surprised if it did.

In the end, the best thing is flexibility. Sure, have these checklists and protocols in place but they should be malleable when there is a logical reason why they should be. Furthermore, training programs should be allowed to do what they want with regard to call or 16h shifts. You know what kind of program you are going into and you choose that kind of program. I knew the kind of program I signed up for as did everyone else when they interviewed. You don't want a call system, well don't apply to any that have a call system. Simple.

/rant

 

[Law2Doc]

I can understand the argument that work hour restrictions deprive residents of training opportunities, but what you're saying is completely absurd.

You are not incapacitated when you are tired. Your brain still works. You are just tired. Most of the folks a couple of years into residency worked 30 hour shifts and really weren't incrementally more dangerous to our patients. The folks a few years further back sometimes worked even longer shifts than that and didn't screw up a ton either.

The only folks who would equate a long call night to being inebriated or incapacitated are folks who have never worked such a shift. You feel like crap, and feel tired, and because of that most of the time you are excessively careful. More errors happen when you aren't focused on being careful, and are more focused on doing things quickly. You guys working 16 hour shifts won't experience this, but that doesn't make it absurd.

 

[45408]

I think my point is you do the study first, and then make the change, not make a series of changes hoping the studies bear them out. So if you show people make a lot of errors working 100 hours, and fewer at 95, but then it plateaus at 80, then with a straight face you can cut it to 80. And then you look at the 30 hour shift and see where it plateaus, and the plateau is probably around 24+ hours, and so you cut it to that. But to make changes without any basis, and force fields like neurosurg to forego important training opportunities because the public thinks theyd rather have a well rested doctor instead of a better trained doctor seems pretty unreasonable.

The best part is that the public thinks that we should work much shorter shifts and that we work a lot less than we do. They're in total La-La Land compared to reality:

Respondents estimated that resident physicians currently work 12.9-h shifts (95% CI 12.5 to 13.3 h) and 58.3-h work weeks (95% CI 57.3 to 59.3 h). They believed the maximum shift duration should be 10.9 h (95% CI 10.6 to 11.3 h) and the maximum work week should be 50 h (95% CI 49.4 to 50.8 h), with 1% approving of shifts lasting >24 h (95% CI 0.6% to 2%). A total of 81% (95% CI 79% to 84%) believed reducing resident physician work hours would be very or somewhat effective in reducing medical errors, and 68% (95% CI 65% to 71%) favored the IOM proposal that resident physicians not work more than 16 h over an alternative IOM proposal permitting 30-h shifts with ≥5 h protected sleep time. In all, 81% believed patients should be informed if a treating resident physician had been working for >24 h and 80% (95% CI 78% to 83%) would then want a different doctor.

http://www.biomedcentral.com/1741-7015/8/33/abstract

Most individuals surveyed (85%) said they felt residents should work no more than 12 consecutive hours, and 86% responded that physicians should work fewer than 80 hours per week.

The “stark discrepancy” between what the public wants and how many hours residents actually work is a cause for concern, said the study authors, led by Alexander Blum, MD, of the Department of Health and Evidence Policy at the Mount Sinai School of Medicine in New York City.

More than four in five survey respondents believed that patients should be informed if the doctor treating them has been working for more than 24 hours, and a similar number of people said they’d request care from another physician if they knew their doctor had been working for so long with no sleep.

http://www.kevinmd.com/blog/2010/06/public-resident-physicians-work.html

Yeah, I bet you're also less likely to make mistakes when you're drunk too, right?

Comparing sleep deprivation on call to being drunk is something that people who haven't been a physician on call do. They're not equivalent, IMO.

 

[SteinUmStein]

You are not incapacitated when you are tired. Your brain still works. You are just tired. Most of the folks a couple of years into residency worked 30 hour shifts and really weren't incrementally more dangerous to our patients. The folks a few years further back sometimes worked even longer shifts than that and didn't screw up a ton either.

The only folks who would equate a long call night to being inebriated or incapacitated are folks who have never worked such a shift. You feel like crap, and feel tired, and because of that most of the time you are excessively careful. More errors happen when you aren't focused on being careful, and are more focused on doing things quickly. You guys working 16 hour shifts won't experience this, but that doesn't make it absurd.

I can't make any comments on the appropriateness of work hour restrictions, but saying that we're not incapacitated on some level by sleep deprivation is just plain wrong.

 

[MilkmanAl]

Sweet Jesus, this thread is terrifying. I'm amazed how many people support working crazy call schedules and longer hours. Oh well, you guys have fun with that.

 

[Law2Doc]

Sweet Jesus, this thread is terrifying. I'm amazed how many people support working crazy call schedules and longer hours. Oh well, you guys have fun with that.

Again, it's not that anyone likes longer hours. I sure don't. It's that some folks are getting later into residency and starting to realize that soon they will be working without a net, and that seeing a case that walks into the hospital at the end of shift or being able to participate in a procedure that will likely run long sometimes will be infinitely more valuable to you and your training than a few more hours of sleep. You'd like it to be your choice, not some arbitrary, non-evidence based decision. You'll start to appreciate this later in residency, where you start ti realize that in a few years you are F'ed, and are going to be even more F'ed than the folks a few years ahead of you who worked longer shifts.

 

[Law2Doc]

I can't make any comments on the appropriateness of work hour restrictions, but saying that we're not incapacitated on some level by sleep deprivation is just plain..].

Anyone who has worked a 30 hour shift (or longer)knows it is nothing like being drunk, and wouldn't equate the two. You will be cognizant about the fact you are tired, and will double check things a lot. The end result is that folks at the end of long shifts aren't killing their patients like you might if you were truly incapacitated or inebriated. It's telling that it's the med students and premeds yet to work such schedules (and currently not likely to work such schedules until they are attendings, when there is no safety net) calling this absurd, not the residents on this thread.

 

[SteinUmStein]

Anyone who has worked a 30 hour shift (or longer)knows it is nothing like being drunk, and wouldn't equate the two. You will be cognizant about the fact you are tired, and will double check things a lot. The end result is that folks at the end of long shifts aren't killing their patients like you might if you were truly incapacitated or inebriated. It's telling that it's the med students and premeds yet to work such schedules (and currently not likely to work such schedules until they are attendings, when there is no safety net) calling this absurd, not the residents on this thread.

I never said it was anything like being drunk, I've been sleep deprived before and I know how it feels. I'm just saying that it most definitely impairs your performance and judgement on some level. That may or may not be a good enough reason to limit clinical work hours, but I see no point in denying that we are human beings who have limits and for whom sleep is a biological necessity.

 

[45408]

Sweet Jesus, this thread is terrifying. I'm amazed how many people support working crazy call schedules and longer hours. Oh well, you guys have fun with that.

Yeah, it must be all that Kool Aid.

 

[MilkmanAl]

Agreed.

 

[beethousand]

Again, it's not that anyone likes longer hours. I sure don't. It's that some folks are getting later into residency and starting to realize that soon they will be working without a net, and that seeing a case that walks into the hospital at the end of shift or being able to participate in a procedure that will likely run long sometimes will be infinitely more valuable to you and your training than a few more hours of sleep. You'd like it to be your choice, not some arbitrary, non-evidence based decision. You'll start to appreciate this later in residency, where you start ti realize that in a few years you are F'ed, and are going to be even more F'ed than the folks a few years ahead of you who worked longer shifts.

Just riffing here but what if the acgme allowed for a set number of flex days where you can go over the hour limit? That way you could pick up those cases, procedures, etc. There's Already issues with compliance anyway, why not create a little wiggle room?

 

[Staradmiral]

What is wrong with those doctors? they actually want to work more than 80 hours a week? Medically speaking they should be admitted to a psychiatrist (or be tested for cocaine use)

I personally find the residency hours of the united states and canada to be utterly insane. They should be reduced to 60h/week maximum with 12h shift maximum. There have been numerous deaths due to sleepy doctors. All the experience in the world is useless if you're too sleepy to use it. If it wasn't for the language barrier or long UK residencies I would just do residency in Europe.

I mean look at the Airline Industry. By LAW they are required to have two crews for any flights longer than 8 or 9 hours, because guess what, people's lives are at hand and you don't want to put people's lives in sleepy hands. The same should go for the medical industry. If i were a patient I would dismiss any doctor who tried to treat me if they have worked over 10hours.

 

[dr zaius]

Just riffing here but what if the acgme allowed for a set number of flex days where you can go over the hour limit? That way you could pick up those cases, procedures, etc. There's Already issues with compliance anyway, why not create a little wiggle room?

Or add another year to residency training! (I say this in jest being that there is absolutely no money for this).

 

[45408]

What is wrong with those doctors? they actually want to work more than 80 hours a week? Medically speaking they should be admitted to a psychiatrist (or be tested for cocaine use)

I personally find the residency hours of the united states and canada to be utterly insane. They should be reduced to 60h/week maximum with 12h shift maximum. There have been numerous deaths due to sleepy doctors. All the experience in the world is useless if you're too sleepy to use it. If it wasn't for the language barrier or long UK residencies I would just do residency in Europe.

This is so ridiculous I hardly know where to begin. 60 hours/week? That's nearly the AVERAGE amount that an American surgeon works. That means they frequently work much more when they're on call a few times that week to compensate for their weekends off. You want the residents to be limited to that much? Great, once I get out into practice, I'll call the ED and tell them I've had enough appies and perfed viscuses for the night, please send them away.

PS: there's a correlation between the long residencies in the UK and their short work hours.

12 hour shift maximum? Again, when you're a surgeon in practice, and you've just finished up a full day of cases and are wrapping up at the office, you could easily get a call that your mastectomy patient is hypotensive with bloody drainage in the JPs. Are you going to tell them to do a stat transfer to a facility with a well-rested surgeon? We've had cases go 17 hours (rare, thank God), and you can't scrub out and take a nap.

I mean look at the Airline Industry. By LAW they are required to have two crews for any flights longer than 8 or 9 hours, because guess what, people's lives are at hand and you don't want to put people's lives in sleepy hands. The same should go for the medical industry. If i were a patient I would dismiss any doctor who tried to treat me if they have worked over 10hours.

Guess what? Flying an airplane in the dark is boring as hell. Same goes for truckers. That's why they have such short shift limits. Trust me, I wasn't about to fall asleep when I was in the middle of a ruptured AAA after being awake for 23 hours.

If you were a patient, you'd better not get appendicitis after 5pm, because every surgeon here has been working for 10+ hours at that point.

 

[Staradmiral]

This is so ridiculous I hardly know where to begin. 60 hours/week? That's nearly the AVERAGE amount that an American surgeon works. That means they frequently work much more when they're on call a few times that week to compensate for their weekends off. You want the residents to be limited to that much? Great, once I get out into practice, I'll call the ED and tell them I've had enough appies and perfed viscuses for the night, please send them away.

PS: there's a correlation between the long residencies in the UK and their short work hours.

12 hour shift maximum? Again, when you're a surgeon in practice, and you've just finished up a full day of cases and are wrapping up at the office, you could easily get a call that your mastectomy patient is hypotensive with bloody drainage in the JPs. Are you going to tell them to do a stat transfer to a facility with a well-rested surgeon? We've had cases go 17 hours (rare, thank God), and you can't scrub out and take a nap.


Guess what? Flying an airplane in the dark is boring as hell. Same goes for truckers. That's why they have such short shift limits. Trust me, I wasn't about to fall asleep when I was in the middle of a ruptured AAA after being awake for 23 hours.

If you were a patient, you'd better not get appendicitis after 5pm, because every surgeon here has been working for 10+ hours at that point.

If 60 is around the average, then thats fine. Why should a resident be required to work more?

If a case lasts 17hours, there should be two teams, A competent teams of doctors should be able to explain whats been done and a competent physician should be capable of finishing what another has started (i feel sorry for that patients and the doctors who had to work that long straight)

It's called shift work for a reason. Some doctors start at 7:00am, others start at 3:00, someone overnight, etc. So you always have some rested doctors available. The appenticitis at 5pm is treated by the doctors of the second shift. Not hard...

 

[turkeyjerky]

Or add another year to residency training! (I say this in jest being that there is absolutely no money for this).

Adding an extra year to residencies would be well worth it to hospitals, by that time residents are definitely gonna be pulling their own weight.