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16hr rule & surgery
Started by Marianne11
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I'm unhappy about it. Basically, it seems like its going to force our program to adopt a night float system for all junior residents. This would be an undesirable change from our current scheduling system which gives us two weekends off a month.
It means night float is pretty much required. In programs where night float is already in place, it means more services will have to be under night float. At my program we had several services using night float, and several others that didn't (the latter used a day/night team, with a 24hr call once a week to give provide the mandatory day off.)
That is my understanding unless someone out there figured out a way to avoid these things... PA/NPs, home call for everyone, etc.
That is my understanding unless someone out there figured out a way to avoid these things... PA/NPs, home call for everyone, etc.
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It seems like larger hospitals remain unconcerned about the new restrictions, feeling they have enough staff to cover. The real concern seems to be coming from the smaller hospitals, where most PD's feel they're being forced to institute a night float system. Some PD's are being more creative with when residents come in for their particular call, but it seems like the incoming year will be the guinea pigs no matter what. That's the only part that concerns me.
I've heard a lot of "we're not sure yet but we will definitely find a way to be compliant." Some residents are bitter as their work load will increase (given that interns can't be the sole doctor at night) and they think it's unfair that we're gonna have it "that good." Whatever, it only effects intern year, so I'm not too worried about it...
1) Surgery interns aren't the sole docs at night because there are always upper levels around for emergent surgeries (at least the programs where I interviewed and the one where I am a resident).
2) Surgery interns will still be on call nights, and so will other junior residents.
3) I think its a mistake to think this will improve intern life OR that it will only affect intern year. As I've already stated, I think its actually going to make everyone's schedule worse where I am though I obviously can't speak for other programs.
At my program they haven't been able to find a way to work a new schedule JUST for the 16-hour interns while maintaining our current schedule for everyone else. Thus, all junior residents (1-3 at my 6-year program) will likely get schedules similar to the incoming class of interns. I'm not at a tiny or super large program either - we have 4 categoricals per year in a 6-year program.
Additionally, I think the new rules are likely to adversely affect your learning curve during intern year, which will definitely have a ripple effect going into the rest of your training. Obviously there's nothing we can do about it but try to work within the system, but I think it is foolish to get lulled into complacency thinking that this will "only affect intern year."
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Also, post-call sleep is the most delicious sleep ever. You will totally miss out on that.
I see your point. I did not mean to down play the longterm implications, just the annoyance of abiding by such rules. Like you said, we have to find a way to make the best out of a poor situation. I'll report back in a year 😎
Exactly. What I've been hearing is: Same 85 hour week limit - Call = One less weekend off per month. Interns will be working more days with similar total weekly hours only without the beautiful post-call days. And more suck gets passed on to the R2/R3s.
I've only encountered one surgical resident who thought the 16 hr limit was a good thing (I thought her reasoning was wishy-washy personally). Everyone else thinks it'll make things worse.
I think intern life will be worse since there wil be more pressure to lie about your hours.on paper.
Seniors wil be effected too since they will be the ones who have to create exotic schedules to satisfy the limits with less people. If you are wasting time on making schedules, you arent thinking about surgery.
The work hours wont be noticeable at strong programs with PDs who help with the schedules and expectations.
The last thing a resident needs to worry about is logging hours to satisfy beaurcracy
Seniors wil be effected too since they will be the ones who have to create exotic schedules to satisfy the limits with less people. If you are wasting time on making schedules, you arent thinking about surgery.
The work hours wont be noticeable at strong programs with PDs who help with the schedules and expectations.
The last thing a resident needs to worry about is logging hours to satisfy beaurcracy
More night float. Which then translates to less operative experience since you'll only be scrubbing in on emergent cases. RRC will then have to try to figure out how to deal with potentially putting programs on probation that are following their rules rules because residents may possibly be unable to get the case numbers.
I agree with all of this. This is affecting my program's rotation structure period, not just for the interns.
I think next year (when I am still in the junior/intern call pool for a good part of the year) is going to suck - I'm worried about how this will affect my operative caseload (though as a 2nd year I could potentially stay past the 16 hours to operate) as well as my overall experience.
Interesting video of a Grand Rounds given by a Chief Resident from the University of Alabama. It's mostly about "Obamacare," but it addresses the idea of residency work hour limitations as an example of the greater loss of control of the profession. Start at about 13 minutes if you just want to hear a short discussion of work hours, the 16-hour shift, etc.
Great quote: "we should not be subject to an organization that does not understand the difference between training a dermatologist and training a surgeon."
http://vimeo.com/11378278
OK, I tried to embed it. It didn't work.
Great quote: "we should not be subject to an organization that does not understand the difference between training a dermatologist and training a surgeon."
http://vimeo.com/11378278
OK, I tried to embed it. It didn't work.
While I do think that there needs to be some sort of limit on work hours during residency, I think this 16HR intern rule is crap... Quite honestly, once out in the "real world" there are no work hour limits. As an Attending no one sends you home because you are "over your limit on duty hours", so unfortunately I think the up and coming surgeons (myself included) will be at a slight disadvantage in the long run... but hey, that's the law so we have to roll with it...
Yet... I would be pleasantly surprised if there are no duty hour restrictions for attending physicians by the time any of us medical students become attendings.
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Osteopathic programs will NOT be implementing the 16-hr rule next year.
This is my concern. 85hrs/wk when actually followed has in some programs shown drops in cases. The drop still left adequate but significantly lower numbers. The change may push more of the operative experience to later years.
Often, residents, IMHO think of many concerns and complaints as in a vacuum. I look for the domino effects and bigger picture. PGY1 and sometimes PGY2 residents often have more baseline "academic" or non-operative education requirements. These include the increasing drive for simulation education. With ever increasing limits on hours and call, the stories of five or more years ago of interns getting to be primary resident on major cases or getting to double scrub will likely have to be sacrificed. With less interns and junior residents in general double scrubbing on big cases, they will be less prepared as seniors to actually "do" such cases. That is one of the potential domino effects....
All that said, I am not claiming to know the caliber change if any in future grads. I am merely saying we should think about these things and at least anticipate, plan, and/or adjust our teaching models to adjust and or prevent negative consequences beyond just lack of available bodies.
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I think it's going to suck, for the interns and for the other juniors. Terrible idea.
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