New work hour regulations???
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Its real. Ive heard 56 hours though.
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Blade28
I haven't heard anything yet - is this in all fields?
What a F*cking joke. I think 80 hours is a perfectly reasonable average week for training. How are you possibly going to come out of residency @ 56 hours a week, a trained surgeon knowing what to do before you're 40? To make just a proportional argument you'd need to extend residency by 2 years and that doesn't take into account that you'll still need to have people on during low operative volume times eliminating OR time to an even greater extent than represented by the pure hourly cut. Wait now, it gets worse. More years = more residents working during the daylight hours (an additional number of residents per class/year) equals even less operative/patient volume per day during those years.
and talk about quality. There are allready some people coming into surgery thinking its "lifestyle friendly". Lets further this trend and get some real lazy asses in there.
and talk about quality. There are allready some people coming into surgery thinking its "lifestyle friendly". Lets further this trend and get some real lazy asses in there.
Neurosurgery would be what, a 12 year residency then? Madness.
One thought is that it will develop into a more graduated program where you advance based on demonstrated ability. SIU's program director is one of the leaders in the development of a program that requires you to demonstrate proficiency in a particular procedure prior to entering the OR and practicing on a human. It consists of animal labs, cadaver labs and computer simulations. If our hours are cut more, it seems this is the system that will be implemented. Not everyone will finish in 5-years, but the true wizards of each surgical residency may.
complete BS. This would be feasible for peds or family but would be a nightmare for surgical programs.
😱
So what kind of restrictions would be put on programs such as the approved/accreditted number of residents allowed per year - how would this be managed if you are advancing some and not others. Additionally, what would prevent programs from keeping residents longer to do the scut work, etc at the cheaper pay scale?
Does anyone have any links to such information as I have never heard of this before.
Thanxz.
So what kind of restrictions would be put on programs such as the approved/accreditted number of residents allowed per year - how would this be managed if you are advancing some and not others. Additionally, what would prevent programs from keeping residents longer to do the scut work, etc at the cheaper pay scale?
Does anyone have any links to such information as I have never heard of this before.
Thanxz.
B
Blade28
Uh...can someone provide a link to this new regulation?
I haven't heard anything about this. I mean, there's always been talk, but that's for the far, far future.
I haven't heard anything about this. I mean, there's always been talk, but that's for the far, far future.
That's an issue that looked at in the late 1990's before settling on the 80 hour week. There is nothing up for discussion by the RRC, american college of surgeons, or ACGME on this topic. I think everyone has settled on 80 as a satisfactory compromise.
I have also heard about it.
Why do those people that try to impose hour rule regulations on us, don't spend a little more time trying to get useful things done?
Such as increasing pay, retirement accounts for every resident, benefits, etc.
I definitely don't want to spend more years than the 5-9 years that I am already going to put on. There is no way that one can be equally trained in 60 hours/wk in surgery. Not just because of the hours but because of the changes that would have to be taken to lower 20hrs/resident/wk. We are talking for an average program of 4 residents/year, 80 HOURS. That means that program must add another resident or PA to cover those hours, which means less OR time, not to mention the same # of cases spread out over 5 residents and not 4. And purely based on hours, that is 5000 hours over 5 years. (1 year during the current 80 hours is about 4000).
That is OVER ONE YEAR OF TRAINING LOST!
I would rather they pay us 10k more each and save all the trouble. I think that all in all we get paid so poorly that it is insane. I know the average person makes bla bla bla... But the average person started working when they were 18-22, not 29+. That's 10 years of lost income added to the huge debt we are most in. Even in social security benefits and retirement accounts we are WAY behind the rest!!! (sorry to go off on a tangent)
I know that other specialties already have some regulations in place in some hospitals (ER 60hrs/wk). I think for some specialties it would work, but not for surgery.
From what I have heard in Europe it is down to 36 hours!
Why do those people that try to impose hour rule regulations on us, don't spend a little more time trying to get useful things done?
Such as increasing pay, retirement accounts for every resident, benefits, etc.
I definitely don't want to spend more years than the 5-9 years that I am already going to put on. There is no way that one can be equally trained in 60 hours/wk in surgery. Not just because of the hours but because of the changes that would have to be taken to lower 20hrs/resident/wk. We are talking for an average program of 4 residents/year, 80 HOURS. That means that program must add another resident or PA to cover those hours, which means less OR time, not to mention the same # of cases spread out over 5 residents and not 4. And purely based on hours, that is 5000 hours over 5 years. (1 year during the current 80 hours is about 4000).
That is OVER ONE YEAR OF TRAINING LOST!
I would rather they pay us 10k more each and save all the trouble. I think that all in all we get paid so poorly that it is insane. I know the average person makes bla bla bla... But the average person started working when they were 18-22, not 29+. That's 10 years of lost income added to the huge debt we are most in. Even in social security benefits and retirement accounts we are WAY behind the rest!!! (sorry to go off on a tangent)
I know that other specialties already have some regulations in place in some hospitals (ER 60hrs/wk). I think for some specialties it would work, but not for surgery.
From what I have heard in Europe it is down to 36 hours!
B
Blade28
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That's what they are trying to figure out.
This would be devastating to Rural hospitals. Think about those >50 bed hospitals out there that have two or three general surgeons in them who are all baby boomers looking to retire or at least cut down on hours.
by adding 2 years to the residency not only will there be a two year gap but competition and even fill rate will decrease for the longer residencies.
by adding 2 years to the residency not only will there be a two year gap but competition and even fill rate will decrease for the longer residencies.
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according to our program director this was something congress had a meeting on this past december 2007. the national institute of medicine is considering implementing the restrictions. if medicare follows these guidelines they would also cross over to docs in practice. ie if it can be documented that attending x worked more than 60hrs a wk, then he will no longer get paid by medicare/ insurance.
this is a very real discussion that is happening on the national level. rrc, acgme, and acs would be only bystanders; they have minimal say.
If this is the case, it is just a back-handed way to cut our salaries...
Hmmm, Europe is not a country... It's 27 different countries, with different work regulation, etc, etc...
For instance, in France, surgery resident may work up to 100 hours a week (no hour restriction), the only obligation is not to see patients the day after you've been on call (meaning you can do paper work,...)... But this is not strictly respected, and most of the resident are working the day after (that being said, we are released a bit earlier than our collegues that were not on duty the night before!)
In Denmark a surgery resident is supposed to work 35 hours a week, it's true... But if he goes over 35 hours, he's not punished, he's payed extra hours!
If that were the case I think there would be some kind of substantiation for it on the internet: the websites of the stakeholders, or news articles. No discussion with such potential impact would get very far without publicity.
Also, it's the ACS, not ACOS...I'm not even in the field and I know that much...
Haven't been following the thread that closely - but isn't it possible that "ACOS" refers to the American College of Osteopathic Surgeons, which is separate from the ACGME and ACS?
Amgen actually IS in the field, so if it's not a typo then I presume that he/she is referring to the osteopathic surgery body.
Ah, very good point, although amgen was quoting someone else who did spell out "american college of surgeons." That was a petty bit that I shouldn't have included anyway. I'd remove it now if it weren't already quoted.
However, I stand by my point that if congress were seriously looking at changing resident work hours, to say nothing of those of practicing physicians (sorry, but that part is utterly ludicrous), we would be hearing about it from many channels.
If this is true and is implemented it will be a disaster as far as I can see. I mean, training will be longer, and maybe even deficient as work and therefore learning opportunities are diluted among residents. I also find ridiculous that this will also somehow affect attendings.I mean if you have a patient who needs you to come in to the hospital on a weekend what are you going to do or say "Im sorry Mr.HMSbeagle, I can't see you because I'll go over my hours". This is ridiculous and irresponsible. I hope this isn't true as I and I'm sure everyone here wants at least a decent training in residency. If this comes forward, coupled to decreasing reimbursement, I think this would be very bad for the medical profession. Possible candidates would not want to go into medicine because of this crap.Thanks and sorry for the rant.
I'm only an MS2, but 80 hours seems reasonable to me. Most professional job's that are serious are at least 60 hours when straight out of college. All my business and law friends are pulling 80-120 hours easy.
Instead of f'ing with the time, why don't they force the programs to give us the full 100k per year they are awarded by the gov to train us. My opposition to slaving my life away for residency drops tremendously if I'm at least well compensated for it. Not to mention now that we can't defer are loans any more. $$$ talks! (Back of the napkin calculation... 9.62$ an hour for 40k for 80 hr work week 52 weeks a year! I made more in high school!)
Instead of f'ing with the time, why don't they force the programs to give us the full 100k per year they are awarded by the gov to train us. My opposition to slaving my life away for residency drops tremendously if I'm at least well compensated for it. Not to mention now that we can't defer are loans any more. $$$ talks! (Back of the napkin calculation... 9.62$ an hour for 40k for 80 hr work week 52 weeks a year! I made more in high school!)
Man, Im about to start this long tunnel. I really hope residencies dont drag out 10 years. At a certain point, it just wouldnt be worth it...'give up' 14+ years and a few hundred k of debt? I dont think so.
I think this would dissuade a lot of people from going into the field. Medicine so far is a calling for me, but after a certain point, it just wouldnt be worth it.
I think this would dissuade a lot of people from going into the field. Medicine so far is a calling for me, but after a certain point, it just wouldnt be worth it.
okay so this statement got my attention, not sure what you mean by this because last time I was aware - we can still defer during residency. Is this too something I have not heard about. Someone please help!!
http://www.ama-assn.org/amednews/2007/12/03/prsd1203.htm
It's not a guarantee that you'll be able to defer your loans by the time you hit residency. Plus, depending on how much you owe, you might not be eligible anyway.
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Key, Key, Key point here
Deferment = don't pay, don't accrue interest. Eligibility depends on amount of debt. May be discontinued
Forbearance = don't pay, do accrue interest. Available to everyone, no discussion of ending this.
This discussion does NOT mean you will have to repay student loans on a resident's salary.
Yes, this says the Institute of Medicine is going to examine the issue of resident hours and generate a report in 18 months. It's not a legislative body, and no mention was made of specific limits nor of anything pertaining to attendings.
If people think that out of nowhere Congress is going to swoop down and sharply limit the hours of attendings, they are woefully ill-informed about our political process. Things like that don't happen without some reason, usually either a huge crisis or extensive lobbying by someone. This is like all the people who think we will end up with "socialized medicine" if a democrat is elected president. (Note "president" not king.)
Actually just talking about this subject with two attendings about an hour ago. Apparently they are hearing rumors about trying to regulate attending work hours, also. I don't know where they are hearing it from, or if it is just out there in the world of rumors.
Now, the reasoning that one of them had presented was something along these lines. Say you are in the OR until 1:30 fixing a ruptured AAA. Well, then your next morning's cases get delayed until, 9:30 or so, thus guaranteeing that you have had 8 hours off between work times. My question was "Are we truck drivers?" And the anwer was, that yes we regulate how many hours truckers can drive at a federal level in order to assure that they are well rested. So the thinking is that mandating time, would ensure well rested and alert physicians.
I am not agreeing with the thought process. There are MULTIPLE things wrong with it, but that is somehow the twisted line of logic (from what I hear).
Now, the reasoning that one of them had presented was something along these lines. Say you are in the OR until 1:30 fixing a ruptured AAA. Well, then your next morning's cases get delayed until, 9:30 or so, thus guaranteeing that you have had 8 hours off between work times. My question was "Are we truck drivers?" And the anwer was, that yes we regulate how many hours truckers can drive at a federal level in order to assure that they are well rested. So the thinking is that mandating time, would ensure well rested and alert physicians.
I am not agreeing with the thought process. There are MULTIPLE things wrong with it, but that is somehow the twisted line of logic (from what I hear).
This is ridiculous and I hope this doesn't come through. What if you are operating and you time out? Or say, you have to start later the next day because you have to get your 8 hours of rest but one of your patients has an overnight complication and you have to come to the hospital but are not allowed? This truly is worrisome and irresponsible thinking and this would also make lawyers happier as I assure you they will try to make a buck or two on this.
You are correct. IOM is not a legislative body. However, much of the US health policy decision are made based on their recommendations:
you are also correct that the specific focus of this study was resident work hours. However, as per my our faculty who attended one of these inquests, there was significant discussion about extending these restrictions to those in practice.
The gov't can easily regulate hours through medicare mandates (without legislative approval). ie if you work past the x hours set by medicare you won't get paid. Insurance companies base their rates on medicare's rates. They would jump at the opportunity not to pay for services rendered.
In several of the "education" lectures at clinical congress there have been mention of further reducing resident hours, as well as moving to a competency basis for advancement. Most are opposed to further reducing hours without any evidence of improved outcomes. Competency has been a buzz word, and a competency basis for advancement will likely become a reality at some point. The problem will be validation of the system.
Agree with above poster that validating such a system will be a big problem. I don't think that is a good idea. In the current system at least they guarantee you that you'll be competent because of the time factor. People who have an input in this may have forgotten how things are done on a daily basis, and I think it is very dangerous when someone behind a desk decides these kinds of stuff regarding competence. Certainly educational objectives and opportunities will not be be the very best. Not that they are now, but they'll probably be worse. Also this would come at a big economic burden to hospitals because someone will have to run the hospital while the residents are home. Patient care may even suffer more than it does because of fatigue, etc. Just my two cents. Anyways I think the majority of people agree that 80hrs is about right. What I think should be done is to enforce the 80hrs rule more aggressively.
56 hrs has been the regulation in continental Europe for some time now... and there are a lot of problems with it.
Since advancing through the ranks is so stiflingly frustrating there there is little reason to put in 80 hours per week.
I've heard GBR may do some 56 week hour stuff too... Their solution may be that advancing and graduating out of training is not based on # of years but # of procedures....
It just wouldn't work for our system.
Since advancing through the ranks is so stiflingly frustrating there there is little reason to put in 80 hours per week.
I've heard GBR may do some 56 week hour stuff too... Their solution may be that advancing and graduating out of training is not based on # of years but # of procedures....
It just wouldn't work for our system.
I was reading the ACS news yesterday and saw that the ACS is putting or has a committee looking into how they could change residency and the hours. Apparently there is a committee in congress who is looking into medical errors and morbidity/mortality and the fact that studies are coming out showing no difference in error rates pre and post 80 hr work week. It sounded like the ACS was trying to be proactive to get some ideas. My guess is somewhere down the line there is going to be a serious discussion about residency if not attending hours and medical error.
I realy don't see any further work hour cuts in the future for residents, at least in surgery. The ABS has worked hard to develop fast tracks for surgical specialties. As it stands many in those fields don't think fast track residents/fellows are equal to those who did it "the old way". To work to further reduce hours would be silly.
ahh... Now we truly move to the "good old boy" system.... Well that's not true, it's now more visible that's all.
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I've never checked what the timelimit is, nobody has complained even though 80 h can easily be reached with two nights on call. Also no complaints if we want to scrub in on an intresting case the next morning, like tomorrow morning 😀.
I guess the EU will contact me when they think I work too much...
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Blade28
Priceless! http://img149.imageshack.us/my.php?image=img00047yo4.jpg
here is a pic I took at the ACS conference in New Orleans. the speaker said that the hours will be like Europe in 5 years. The consequences for future trainees is crazy (increased number of years, less exposure, less cases ect...)
here is a pic I took at the ACS conference in New Orleans. the speaker said that the hours will be like Europe in 5 years. The consequences for future trainees is crazy (increased number of years, less exposure, less cases ect...)
What do people think about the lack of continuity of care that occurs because of the 80 hour work week? As a student I've developed the impression that a good portion of residents time is spent in sign out. As you cut down the hours, there are more sign outs, which become increasingly brief and this is when mistakes are made.
Also, I have heard repeatedly from surgeons that trained pre-80 work week that residents will be rudely awakened when the get out into the "real world" and start practicing when there is no time limit. They argue their training prepared them physically/psychologically for the rest of their career. I tend to agree with their logic.
Also, I have heard repeatedly from surgeons that trained pre-80 work week that residents will be rudely awakened when the get out into the "real world" and start practicing when there is no time limit. They argue their training prepared them physically/psychologically for the rest of their career. I tend to agree with their logic.
I dont think we can adopt a european model. Residents provide much needed cover for hospitals. You just can't leave the hospital without cover. Also, training time will be eternal, and I hope they remember many of us students have huge debts and a need to work.
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