OMFS Resident Work Hour Restrictions.

[ClandestineDime]

The ACGME oversees physician residencies and has multiple restrictions in place to protect residents from working more than 80 hours a week and from working longer than 24 hours. These changes were mandated by law after a legislature's daughter died due to a medication error made by a sleep deprived resident. Dental residencies however fall into a different category than physician residencies and are therefore not bound by the same regulations. This leads to residents working 100+ hours a week.

Is anyone aware of a group that advocates for work hour restrictions in dental residencies, OMFS in particular? If not, is anyone interested in starting one? CODA needs to catch up and protect the residents it presides over.

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[deleted1047421]

This is the nature of omfs.
There will be hard work and long hours.

I remember my first year of residency I was doing 120-130 hours a week. There was a busy stretch where I didn’t leave the hospital for two weeks. I just slept in one of the call rooms instead of going home which saved a few minutes of driving.

The alternative is that the program/department will add residents. This is going to be bad for resident education. The experience will be diluted. Adding a resident/residents will lead to less cases you cut as a junior and senior resident. Trust me you don’t want this. You want to eventually cut as many cases as possible.

 

[OMFSLife123]

Obviously, no one wants negative outcomes period, let alone from a sleep deprived resident. The majority of programs in their accreditation paperwork state that they mirror the 80 hour work week policy off of the GME model. I agree with silver arrow though, I, as a current resident, would directly oppose anyone who is trying to start a group to raise hell.

 

[amali]

Once one comes to the realization that OMFS residents have no rights...life becomes a little easier.

 

[deleted1047421]

Once one comes to the realization that OMFS residents have no rights...life becomes a little easier.

All jokes aside… I know residency training is tough for all omfs residents.
I know a couple residents personally who got into car accidents being post call and driving home. One happened to my long time mentor when he driving home from being post call during residency, another happened to a lower level resident in the program I was in and the car accident was decent sized. Both luckily didn’t have any injuries or consequences.

https://www.aaoms.org/docs/education_research/edu_training/aaoms_faculty_resident_summary.pdf

Having an increased amount of residents not only would significantly affect the educational experience negatively, we are also talking about adding a significant amount of oral surgeons to the workforce. I don’t want to have to spell things out for you guys but the numbers of graduating residents are pretty low and have stayed this way for many years.

 

[DMD12345]

I’m not saying I’m for this, I’m actually wanting to go to a program that pushes the s*** out of me, but for the sake of discussion what about adding another non-cat to those programs that consistently have interns doing 120hr weeks? It’d cut the intern hours down while keeping the upper level cutting and graduating resident numbers the same. I can see its own set of cons though.

Edit: btw, are there actually still programs that do have interns work 120hr+ weeks consistently?

 

[ShortShortsDad]

I think most people, whether out for a few minutes or a few decades, have the mentality that we walked uphill to school both ways in the snow. That being said, I was finishing up my residency when COVID hit and our tempo was crushed like I think many programs were. While I did a few 120 hour weeks intern year most were 80-100 but when I graduated my interns weren’t coming close to 80hrs. I haven’t objectively seen the numbers in a couple years but talking to the residency director their numbers are still way down which will mean way down on hours too.

At one point I did a 60 day stint as chief covering 24/7 call for level 1 and affiliated peds hospital. That sucked and I came close to losing it but it’s those experiences that make you able to crush it on the other side

 

[deleted1047421]

I’m not saying I’m for this, I’m actually wanting to go to a program that pushes the s*** out of me, but for the sake of discussion what about adding another non-cat to those programs that consistently have interns doing 120hr weeks? It’d cut the intern hours down while keeping the upper level cutting and graduating resident numbers the same. I can see its own set of cons though.

Edit: btw, are there actually still programs that do have interns work 120hr+ weeks consistently?

In theory what your saying can work. Many programs do have non categorical.

The high volume long hours will train you to become efficient, manage stress and shape/force you to become an effective resident. These skills are built starting day 1. Being an omfs is not just about the operational ability you learn in junior and chief year. Dilution of the intern year will have its consequences on resident education.

You will eventually understand once you get in and graduate.

 

[nonociceptors]

Anyone who says they are consistently working 120+ hour weeks is either full of **** or unintentionally exaggerating their hours. You’re just not. I don’t care where you go. Yeah we work long hours but so does every other resident in the hospital.

 

[OMFSLife123]

Anyone who says they are consistently working 120+ hour weeks is either full of **** or unintentionally exaggerating their hours. You’re just not. I don’t care where you go. Yeah we work long hours but so does every other resident in the hospital.

or a completely inefficient intern who takes 120 hours to do 60 hours of work

 

[deleted1047421]

Anyone who says they are consistently working 120+ hour weeks is either full of **** or unintentionally exaggerating their hours. You’re just not. I don’t care where you go. Yeah we work long hours but so does every other resident in the hospital.

Not every program runs the same way and some will be busier than others.

Here is a scenario for intern year.
No noncategoricals. Just the residents. They take in house call 3-4 times a week. In house call is mandatory. They are based out of a level one trauma center. They take the majority of facial trauma. My program in particular plastics didn’t take facial trauma. Ent took facial trauma call one day a week. No gpr or dental school affiliation. They take all infections and I and Ds. Heavy orthognathic program with tons of orthognathic work ups. Work ups get done after hours. Interns have to run a very busy clinic doing charts way past midnight in between er pages, rounding on in house patients and fielding the endless consults (a ton of cardiac patients needing teeth out which typically gets tons after hours- often even in the middle of the night ). A tom of after hours OR cases as many private attendings also come to help out to staff or cases after they’ve done a full day in private practice. OR cases 7 days a week. Lower level residents stay after hours to assist the chiefs. Even if your not on call your staying late anyways.

Yes other services work long hours. But most other services are not short staffed like a lot of omfs programs are.

The places I externed… hours were just as heavy if not more. It’s not a fantasy. These hours add up. Your program may be different and that’s fine.

 

[nonociceptors]

or a completely inefficient intern who takes 120 hours to do 60 hours of work

Yeah that’s it in almost every case.

Not every program runs the same way and some will be busier than others.

Here is a scenario for intern year.
No noncategoricals. Just the residents. They take in house call 3-4 times a week. In house call is mandatory. They are based out of a level one trauma center. They take the majority of facial trauma. My program in particular plastics didn’t take facial trauma. Ent took facial trauma call one day a week. No gpr or dental school affiliation. They take all infections and I and Ds. Heavy orthognathic program with tons of orthognathic work ups. Work ups get done after hours. Interns have to run a very busy clinic doing charts way past midnight in between er pages, rounding on in house patients and fielding the endless consults (a ton of cardiac patients needing teeth out which typically gets tons after hours- often even in the middle of the night ). A tom of after hours OR cases as many private attendings also come to help out to staff or cases after they’ve done a full day in private practice. OR cases 7 days a week. Lower level residents stay after hours to assist the chiefs. Even if your not on call your staying late anyways.

Yes other services work long hours. But most other services are not short staffed like a lot of omfs programs are.

The places I externed… hours were just as heavy if not more. It’s not a fantasy. These hours add up. Your program may be different and that’s fine.

I’m at one of the busiest in the country. I have friends at other equally busy places. When you break it down nobody is consistently at 120 hours of working.

 

[OMFSLife123]

Not every program runs the same way and some will be busier than others.

Here is a scenario for intern year.
No noncategoricals. Just the residents. They take in house call 3-4 times a week. In house call is mandatory. They are based out of a level one trauma center. They take the majority of facial trauma. My program in particular plastics didn’t take facial trauma. Ent took facial trauma call one day a week. No gpr or dental school affiliation. They take all infections and I and Ds. Heavy orthognathic program with tons of orthognathic work ups. Work ups get done after hours. Interns have to run a very busy clinic doing charts way past midnight in between er pages, rounding on in house patients and fielding the endless consults (a ton of cardiac patients needing teeth out which typically gets tons after hours- often even in the middle of the night ). A tom of after hours OR cases as many private attendings also come to help out to staff or cases after they’ve done a full day in private practice. OR cases 7 days a week. Lower level residents stay after hours to assist the chiefs. Even if your not on call your staying late anyways.

Yes other services work long hours. But most other services are not short staffed like a lot of omfs programs are.

The places I externed… hours were just as heavy if not more. It’s not a fantasy. These hours add up. Your program may be different and that’s fine.

sounds like medstar

 

[ClandestineDime]

Residents are cheap and easy labor. If a program has enough work to do that an intern is consistently working 100+ hours a week, I don't think they need another resident, they need a mid-level provider. I.e. someone who can help pre-round, do evals, and run the clinic more efficiently than a resident who has been awake for 36 hours.

It comes down to two things. Patient safety, and resident well being. Compromising either of those things are not worth it. A sleep deprived resident is inefficient and unsafe.

 

[White_Sponge_Nevus]

Yeah that’s it in almost every case.

I’m at one of the busiest in the country. I have friends at other equally busy places. When you break it down nobody is consistently at 120 hours of working.

I think the calculation of hours varies a lot depending on if you consider writing clinic notes as hours worked or not. Also, if you take in-house vs home call

I did rough math looking back at my intern year and I would say it averaging about 85-90 hours a week, which included the hours spent coming from home call (q4) and NOT including writing clinic notes, which would add roughly 10 hours a week to the total.

I agree that there is likely a lot of exaggeration going on, but I tend to believe that people at some programs can average 110-120 intern year, which sounds horrendous

 

[OMSDoc]

First, the facts.

The original case was the Libby Zion case, where a patient died (in 1984), and the blame was placed on a resident, who was reported to be overworked and taking care of dozens of patients that night. The reason for the death is now presumed to have been due to a medication error.

The father of the patient was not a legislator, but a journalist (and a lawyer). He (Sidney Zion) was renowned in that he revealed much of the Johnson administration's deceit in the Vietnam war. He revealed that Daniel Ellsburg was the source of the Pentagon Papers.

As the dad of a wonderful daughter (see my profile image), I feel for that dad.

The state of New York tried to have that resident prosecuted for homicide.

I am not sure if a good night's sleep would have prevented that medication error, but lets say that it would have. Now, such a medication error is usually stopped by hospital pharmacists...thank God for them.

After the Accreditation Council for Graduate Medical Education (ACGME) passed a rule, the state of New York passed a regulation that residents could work no more than 80 hours per week, among other things. A regulation is not a law (i.e, something passed by the legislature, and signed by the governor), but it is binding nonetheless. I am not sure if any other state has issued such a regulation.

Second, what is really best for the patient? In life, there are always tradeoffs.

If say, a general surgery resident is with a complex patient all night, and the rules mandate that they walk out the door at 7:00 a.m., leaving the patient with the next "shift", then the patient may be left worse off. The patient may be better off, but each case is different.

 

[Life of Pablo]

This might be an unpopular opinion, but I'm just going to say it: why would you choose to do OMFS if you're worried about working too much? I'm not saying working 80+ hours a week is healthy or a good thing, but you could have stuck to general dentistry or done a GPR focused on exodontia. Unlike our medical colleagues, we aren't forced to go through a residency in order to start practicing. Also, if you actually think the 80 hour restrictions are followed by programs - especially surgical residencies - you're wrong. They work 80 hours a week no matter how many hours a week they work.

Idk...I knew full well what I was getting into before pursuing OMFS residency, so getting kicked in the nuts and working more than 80 hours is/was expected.

 

[D1Bound]

This might be an unpopular opinion, but I'm just going to say it: why would you choose to do OMFS if you're worried about working too much? I'm not saying working 80+ hours a week is healthy or a good thing, but you could have stuck to general dentistry or done a GPR focused on exodontia. Unlike our medical colleagues, we aren't forced to go through a residency in order to start practicing. Also, if you actually think the 80 hour restrictions are followed by programs - especially surgical residencies - you're wrong. They work 80 hours a week no matter how many hours a week they work.

Idk...I knew full well what I was getting into before pursuing OMFS residency, so getting kicked in the nuts and working more than 80 hours is/was expected.

I’ve always gotten the impression that certain rotations are horrible, you just try to survive, take a little “breather” on months of anesthesia, get through PGY1-2, and then you’re not drowning anymore

 

[Bereno]

This is an interesting topic. On one hand the more hours you work the more cases you see and the more ingrained the knowledge becomes. My program director used to say that the only problem with taking Q2 call is that you miss half of the cases... The more you learn, the more effective your treatments will be and the more your future patients will benefit from the additional experience. On the other hand is the tendency of long work hours and fatigue to limit critical thinking ability and mental recovery. I think the solution is somewhere in the middle.

I would not support a motion to make a group simply to raise hell on working hours, but I would also not oppose a motion to maintain or improve patient and resident safety and increase learning opportunities.

I think increasing the number of residents is not necessarily the best option either. I think I agree with one of the above posts about adding a mid-level provider to help with rounds and other time intensive and non-critical work. This might help limit the work load, but would not decrease the overall learning opportunities. Would be interesting for some programs to try out and see how it works for them.