80 hour work week!!!

[goinverted]

Hey everyone, I am writing a paper on the attitudes toward the 80 regulated work week for resideny programs and would appreciate your input.

1. How do you feel about the 80 hour regulation?

2. How do you think they will affect resident learning abilitiy?

3. How do you feel it will affect malpractice?

4. Do you feel it will make the idea of becoming a doctor less overwhelming?

5. Do you think it will have an effect on the way older physicians view their replacements?

6. Do you feel that the 80 hour limit will be adhered to or will it be taken more as a loose rule, and why?

Thanks everyone. It is just your opinions so feel free to express them.

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[MD2b06]

Hey everyone, I am writing a paper on the attitudes toward the 80 regulated work week for resideny programs and would appreciate your input.

1. How do you feel about the 80 hour regulation?

2. How do you think they will affect resident learning abilitiy?

3. How do you feel it will affect malpractice?

4. Do you feel it will make the idea of becoming a doctor less overwhelming?

5. Do you think it will have an effect on the way older physicians view their replacements?

6. Do you feel that the 80 hour limit will be adhered to or will it be taken more as a loose rule, and why?

Thanks everyone. It is just your opinions so feel free to express them.

1. It's nice in theory, it would be nice if programs actually adhered to it.

2. Depends on the field. If it's strictly adhered to, the learning opportunities for those in highly procedural fields will probably suffer. Those who are in more cerebral fields will benefit.

3. May decrease the number of incidents of malpractice. Will do nothing to reduce premiums.

4. In theory yes, but those who go into medicine actually believing that programs adhere to a strict 80 hr workweek will be in for a rude awakening.
I pity all my classmates who've matched into general surgery thinking they'll only be working 80hrs/wk during residency.

5. Yes, older attending physicians let us hear abt it all the time. Back when i was training...blah blah blah

6. Think I've already answered this. The RRC only comes around once every 4 years or so. Even then, they announce their visit 3 months in advance. That coupled with the fact that a resident reporting their own program is actually hurting themselves makes it unlikely that anything will change.

 

[ChocolateKiss]

Hey everyone, I am writing a paper on the attitudes toward the 80 regulated work week for resideny programs and would appreciate your input.

1. How do you feel about the 80 hour regulation?

I like it. A lot.

2. How do you think they will affect resident learning abilitiy?

Not much. They will still learn what they need to know and won't have to do it under such stressful circumstances.

3. How do you feel it will affect malpractice?

I don't think it will have a huge effect, but I do think malpractice may decrease a little because residents will make fewer mistakes.

4. Do you feel it will make the idea of becoming a doctor less overwhelming?

Yes, definitely.

5. Do you think it will have an effect on the way older physicians view their replacements?

Yes, many already talk about how easy residents have it now and how they won't ever know how to handle themselves in stressful situations because they are babied during training.

6. Do you feel that the 80 hour limit will be adhered to or will it be taken more as a loose rule, and why?

It will be adhered to when possible, but for surgeons, I bet it will be taken as a loose rule, or they will find loopholes.

Thanks everyone. It is just your opinions so feel free to express them.

 

[happydays]

1. How do you feel about the 80 hour regulation?
That's actually less work than a regular semester for me.

2. How do you think they will affect resident learning abilitiy?
Positively.

3. How do you feel it will affect malpractice?
It will decrease malpractice (than a 100+ hr/wk).

4. Do you feel it will make the idea of becoming a doctor less overwhelming?
Yes, but I'd be prepared to a take a 100+ work week anyway.

5. Do you think it will have an effect on the way older physicians view their replacements?
Perhaps they could think that we'll still learn as well, but we can do it faster.

6. Do you feel that the 80 hour limit will be adhered to or will it be taken more as a loose rule, and why?
Loose rule; you can't stop someone from working in the middle of a surgery.

 

[MSIV]

In terms of adherence...all internal medicine programs that I interviewed at are VERY strictly adhering to the rules. Failure to do so results in harsh penalties. In fact, at many places (including top places like UCSF, MGH) the chief residents rush the post-call team to make sure that they are out on time. The program directors take this rule very seriously.

I don't know as much about the surgery programs, but the surgery programs who have not adhered in the past (like Yale) has had citations against them. Since then, from what I hear from classmated going into surgery, most surgery programs are very strict as well.

So, it seems like everyone is very "pro Bell commision" here. But no-one has stated the reason that many were resistant to it. The shorter the shifts, the more "sign-outs" there has to be (one team giving summaries of their patients to another team). The covering team, who were not present while the patient was being admitted, will never know the patient nearly as well as the primary team. And the more times a patient is handed-off, the more mistakes can happen. Its like the telephone game. And this covering team receives sign-out on 4 whole teams of patients, at times up to 50 people, all of whom they know only from a 30 second summary. So, when they get called in the middle of the night because Mr. Johnson is short of breath, its like "wait, who is Mr. Johnson?" There are many mistakes that can happen this way.

It is true, however, that a Cochrane review has been published showing that less mistakes occur with the 80hr work week, ie there are more mstakes due to exhaustion than due to patient hand-offs. But the study has several flaws, that many older docs are quit to point out.

Don't get me wrong, as someone entering residency in 2 months, I am a big fan of the work hour rules. But I bet that will change if I ever kill a patient in the middle of the night because I underestimated the severity of a situation because I just didn't know the patient well enough.

 

[NapeSpikes]

...ever kill a patient in the middle of the night because I underestimated the severity of a situation because I just didn't know the patient well enough.

I wonder if this is more likely than losing a patient due to poor judgement from overwork (80+)?

 

[8744]

Please vist my humble blog and scroll down to "The Hours Still Suck,"

 

[BooMed]

I would like to see the hours go even lower. 80 hours / 6 days = 13.3 hours per day. Assuming you are sleeping 8 hours per day that leaves you 2.6 hours each day (not counting transportation time to a from the hospital) to spend time with your family, eat, work out, have sex, enjoy life, etc. I mean really, that is ridiculous.

Doctors are not gods. The world will not stop when you leave the hospital.

 

[happydays]

I would like to see the hours go even lower. 80 hours / 6 days = 13.3 hours per day. Assuming you are sleeping 8 hours per day that leaves you 2.6 hours each day (not counting transportation time to a from the hospital) to spend time with your family, eat, work out, have sex, enjoy life, etc. I mean really, that is ridiculous.

Doctors are not gods. The world will not stop when you leave the hospital.

Then just work 80/7=10.1 hrs/day. 10hrs/day is NOTHING. That's 7am to 5pm! I say that this schedule would only suck if you had to commute more than 2 hrs. That's only 2 more hrs/day than most people.

And who are you to say that doctors aren't gods!!?? If I weren't a god, I wouldn't be in this profession.

 

[BooMed]

Then just work 80/7=10.1 hrs/day. 10hrs/day is NOTHING. That's 7am to 5pm! I say that this schedule would only suck if you had to commute more than 2 hrs. That's only 2 more hrs/day than most people.

And who are you to say that doctors aren't gods!!?? If I weren't a god, I wouldn't be in this profession.

No go. You have to have one day off per week.

 

[happydays]

No go. You have to have one day off per week.

Well, that's stoopid. I guess this schedule would suck if you have a family.

 

[BooMed]

Well, that's stoopid. I guess this schedule would suck if you have a family.

Or any other outside interests in life!

 

[happydays]

Or any other outside interests in life!

What?? you have other interests besides medicine? I'm going to have to report you to the Super God of doctor-gods. I'm doing this for your own good.

 

[Depakote]

pft. First this, now you're going to tell me they're going to stop beating the residents like they should.

 

[happydays]

pft. First this, now you're going to tell me they're going to stop beating the residents like they should.

OMG!? WTF??!! They can't do that; that's my whole reason for going into medicine.

 

[humuhumu]

Please vist my humble blog and scroll down to "The Hours Still Suck,"

In case you haven't checked it out yet, Panda Bear's blog rocks (IMHO). Detailed, balanced, entertaining...it's on my bloglines.

 

[gujuDoc]

This would be better posted in the general residency forum where people can actually comment on this stuff because they have the experience to talk from. I doubt many premeds will be able to give an accurate answer to some of these questions.

That said, I don't yet have an opinion because I don't think one can really understand much until they've experienced the hours and the work week either in 3rd/4th year of med school or residency. Hence, I'm undecided on what I think the impact is on the medical field due to this rule.

 

[Touchdown]

In the grand scheme of things, this is only 3 years of your life (most docs work less then 80, more like 60-70) and if thats what you have to do, then so be it!

 

[Its_MurDAH]

I would like to see the hours go even lower. 80 hours / 6 days = 13.3 hours per day. Assuming you are sleeping 8 hours per day that leaves you 2.6 hours each day (not counting transportation time to a from the hospital) to spend time with your family, eat, work out, have sex, enjoy life, etc. I mean really, that is ridiculous.

Doctors are not gods. The world will not stop when you leave the hospital.

sleep 8 hours a day???
A day off during the week??
working out and having sex??
enjoying life???????


You have gotta be joking. This aint a desk job, mate.

Only i suppose you wouldn't exactly be enjoying life having a desk job either...

and yea, we aint gods.
we are lowly servants.

 

[Em1]

I would like to see the hours go even lower. 80 hours / 6 days = 13.3 hours per day. Assuming you are sleeping 8 hours per day that leaves you 2.6 hours each day (not counting transportation time to a from the hospital) to spend time with your family, eat, work out, have sex, enjoy life, etc. I mean really, that is ridiculous.

Doctors are not gods. The world will not stop when you leave the hospital.

Who gets 8 hours of sleep every night??

 

[greendot]

Then just work 80/7=10.1 hrs/day. 10hrs/day is NOTHING. That's 7am to 5pm! I say that this schedule would only suck if you had to commute more than 2 hrs. That's only 2 more hrs/day than most people.

And who are you to say that doctors aren't gods!!?? If I weren't a god, I wouldn't be in this profession.

80/7 is 11.4 ... so, yeah, still not too terrible.

 

[goinverted]

This would be better posted in the general residency forum where people can actually comment on this stuff because they have the experience to talk from. I doubt many premeds will be able to give an accurate answer to some of these questions.

That said, I don't yet have an opinion because I don't think one can really understand much until they've experienced the hours and the work week either in 3rd/4th year of med school or residency. Hence, I'm undecided on what I think the impact is on the medical field due to this rule.

I actually did post it there, but part of my paper is to get pre-med, current med, and post-med student's feelings.

Let's get back to the questions.

Hey everyone, I am writing a paper on the attitudes toward the 80 regulated work week for resideny programs and would appreciate your input.

1. How do you feel about the 80 hour regulation?

2. How do you think they will affect resident learning abilitiy?

3. How do you feel it will affect malpractice?

4. Do you feel it will make the idea of becoming a doctor less overwhelming?

5. Do you think it will have an effect on the way older physicians view their replacements?

6. Do you feel that the 80 hour limit will be adhered to or will it be taken more as a loose rule, and why?

 

[gujuDoc]

I actually did post it there, but part of my paper is to get pre-med, current med, and post-med student's feelings.

Oh ok. In that case, I'll go ahead and try and answer. Thanks for clarifying.


1. How do you feel about the 80 hour regulation?

I think it is a step forward, however, it depends how it is worked. See question 2 for more details.


2. How do you think they will affect resident learning abilitiy?

80 hours is good if it is a precise schedule (i.e. 7am -6pm everday). However, if it is worked where 80 hours means 2 days off and other days living on 2-3 hours of sleep only, by working 36 hours straight with not much sleep then it doesn't really do much for the situation. Most surgeons I've talked to still haven't seen much benefits cuz they still have 3 hours of sleep nights or times when they are on call and don't get an ounce of sleep. So in theory it should help, but in reality there's still a lot that needs to be done to ease the situation.

3. How do you feel it will affect malpractice?

I think if the proper rest is there and people are able to work better, then it should help. However, I don't think it makes as big of an impact as reform in legislation would make. For instance, Florida really could do away with their new 3 strikes and you are out rule.


4. Do you feel it will make the idea of becoming a doctor less overwhelming?

In theory it should help, but we'll see with time whether it does.

5. Do you think it will have an effect on the way older physicians view their replacements?

Not really sure on this one.

6. Do you feel that the 80 hour limit will be adhered to or will it be taken more as a loose rule, and why?

It depends on department and school. A while back I read a story about Hopkins not adhering to the rules and someone in the ER dept calling them out on it. This was reported in the AMSA national publications. Seems the person was found out, though it was anonymous. Said resident got laid off. So I don't know how easy it is to really report violations if they occur. There are tons of schools I'd think that arent strictly adhering to it. However, most people will keep hush hush because they are powerless and can cause themselves their career if they talk. Really in theory all this is nice, but how much it is adhered to is questionable.


Disclaimer, as I go on in my career my views will probably change. Its hard to say now what I will believe later on. But for now, this is what I think

 

[Monette]

1. How do you feel about the 80 hour regulation?
That's actually less work than a regular semester for me.

Yeah but what type of work do you do? That has to be taken into account - I bet it's not nearly as intellectually and/or emotionally draining.

 

[goinverted]

Thanks Guju, awesome reply!

 

[happydays]

80/7 is 11.4 ... so, yeah, still not too terrible.

Sorry. I'm a girl, and girls can't do math.

 

[happydays]

Yeah but what type of work do you do? That has to be taken into account - I bet it's not nearly as intellectually and/or emotionally draining.

There's some truth to that. (During a regular semester), I'm usually out by 8 and back by 11, but I'm not constantly on the move.

 

[goinverted]

Anyone else, here are the questions again

Hey everyone, I am writing a paper on the attitudes toward the 80 regulated work week for resideny programs and would appreciate your input.

1. How do you feel about the 80 hour regulation?

2. How do you think they will affect resident learning abilitiy?

3. How do you feel it will affect malpractice?

4. Do you feel it will make the idea of becoming a doctor less overwhelming?

5. Do you think it will have an effect on the way older physicians view their replacements?

6. Do you feel that the 80 hour limit will be adhered to or will it be taken more as a loose rule, and why?

 

[stiffany]

Hey everyone, I am writing a paper on the attitudes toward the 80 regulated work week for resideny programs and would appreciate your input.

Thanks everyone. It is just your opinions so feel free to express them.

Hi Goinverted. I'm currently working with a national research group looking at some of these questions (but more from the patients' perspective). If you do a general search on pubmed (I'm assuming you're in college and have access to this resource), you'll find studies that have looked at resident satisfaction, operating time (especially for surgeons who are perhaps most affected by the ruling since they worked the most before the rule went into effect on July 1, 2003). You'll also find a lot of studies done in year 2002-2003, when a lot of residency programs implemented the limitation (a year early) as a way of preparing. Also, there are several studies on adherence to previous work hour rules such as the Libby Zion rule instituted in New York State in the 1990s. Finally, you'll find some articles on cases such as Johns Hopkins where they lost their accreditation due to a supposedly anonymous whistle blower (Except, the school found out who it was and kicked the resident out of the program :-().

Good luck.

 

[goinverted]

Hi Goinverted. I'm currently working with a national research group looking at some of these questions (but more from the patients' perspective). If you do a general search on pubmed (I'm assuming you're in college and have access to this resource), you'll find studies that have looked at resident satisfaction, operating time (especially for surgeons who are perhaps most affected by the ruling since they worked the most before the rule went into effect on July 1, 2003). You'll also find a lot of studies done in year 2002-2003, when a lot of residency programs implemented the limitation (a year early) as a way of preparing. Also, there are several studies on adherence to previous work hour rules such as the Libby Zion rule instituted in New York State in the 1990s. Finally, you'll find some articles on cases such as Johns Hopkins where they lost their accreditation due to a supposedly anonymous whistle blower (Except, the school found out who it was and kicked the resident out of the program :-().

Good luck.

Thanks, that is great info! Actually, I believe the resident that tattled at JH's was actually from Utah and now they supposedly have some type of prejudice about admitting Utah applicants. Then again it may just be hearsay.

 

[Messerschmitts]

I would like to see the hours go even lower. 80 hours / 6 days = 13.3 hours per day. Assuming you are sleeping 8 hours per day that leaves you 2.6 hours each day (not counting transportation time to a from the hospital) to spend time with your family, eat, work out, have sex, enjoy life, etc. I mean really, that is ridiculous.

Doctors are not gods. The world will not stop when you leave the hospital.

Hell yeah! How dare they cut into our sex time!? Now all I need is to find a girlfriend and I'll be all set. But I too would like to see it pushed down even further. 80 hours per week is still quite brutal, perhaps needlessly brutal, especially considering that most mortals only work 40 hour work-weeks.

 

[fewchewrmd]

2. How do you think they will affect resident learning abilitiy?

Many believe that a minimum amount of experience (measured in hours) is necessary for adequate training of a physician in a given specialty (say 30,000 hours over 6 yrs for surgery). These people assume that if we decrease hours, learning ability will decrease and therefore the length of residency must be increased to make up for the lost hours.

They fail to recognize the diminishing marginal utility that the 36th hour of being on the clock actually provides as training. After the 14th hour (varies from person to person but it's about 14 for me) the value of each next hour decreases and is almost worthless at the 36th hour. In my opinion, 80 hrs/wk should be sufficient for training good physicians because adding more hours to the week adds very little value (and acually makes people bitter). The only positive side I see to not limiting hours is that it will discourage those who are not whole-heartedly committed to the specialty.

 

[BooMed]

2. How do you think they will affect resident learning abilitiy?

Many believe that a minimum amount of experience (measured in hours) is necessary for adequate training of a physician in a given specialty (say 30,000 hours over 6 yrs for surgery). These people assume that if we decrease hours, learning ability will decrease and therefore the length of residency must be increased to make up for the lost hours.

They fail to recognize the diminishing marginal utility that the 36th hour of being on the clock actually provides as training. After the 14th hour (varies from person to person but it's about 14 for me) the value of each next hour decreases and is almost worthless at the 36th hour. In my opinion, 80 hrs/wk should be sufficient for training good physicians because adding more hours to the week adds very little value (and acually makes people bitter). The only positive side I see to not limiting hours is that it will discourage those who are not whole-heartedly committed to the specialty.

Good point. I have read that after a person has been awake for 24 hours, they have the reflexes and judement of a drunk person. Not a doctor that I want operating on me. Not to mention that sleep is vital for forming long-term memories.

Actually, sleep is important for pretty much every single aspect of human life. It's just the way that our bodies work, we can't change that.

 

[MrBurns10]

I know most of us are just pre-meds, but if anyone knows this...I figure you probably don't get most of the holidays off, but do you get vacation time/sick time in residency? and can you expect to work around 80 hours throughout your residency, or do you end up working more when you're an intern and maybe less when you're high up on the residency heirarchy?

 

[BooMed]

I know most of us are just pre-meds, but if anyone knows this...I figure you probably don't get most of the holidays off, but do you get vacation time/sick time in residency? and can you expect to work around 80 hours throughout your residency, or do you end up working more when you're an intern and maybe less when you're high up on the residency heirarchy?

I have looked at a few residencies just out of curiousity, they allowed two weeks vacation and also some sick time (not sure how much). See Panda's blog (there is a link somewhere in this thread) for good info. on choosing a residency, especially because the amount of time that you are on call seems to vary a lot.

 

[Law2Doc]

5. Do you think it will have an effect on the way older physicians view their replacements?

While I don't know how much of a role the 80 hour work week plays in this, I've heard quite a few comments from older doctors that this current generation of young doctors has far more of an "entitlement" attitude than any preceding it, and that this tends to make them more resistant to go that extra mile they need to to become great physicians. Might be a baby boomer vs Gen Y conflict, but it seems to be an emerging theme.

 

[Law2Doc]

2. How do you think they will affect resident learning abilitiy?

Many believe that a minimum amount of experience (measured in hours) is necessary for adequate training of a physician in a given specialty (say 30,000 hours over 6 yrs for surgery). These people assume that if we decrease hours, learning ability will decrease and therefore the length of residency must be increased to make up for the lost hours.

They fail to recognize the diminishing marginal utility that the 36th hour of being on the clock actually provides as training. After the 14th hour (varies from person to person but it's about 14 for me) the value of each next hour decreases and is almost worthless at the 36th hour. In my opinion, 80 hrs/wk should be sufficient for training good physicians because adding more hours to the week adds very little value (and acually makes people bitter). The only positive side I see to not limiting hours is that it will discourage those who are not whole-heartedly committed to the specialty.

While the consensus agrees with you, hence the rule, virtually every surgical resident I've spoken to disagrees. Their mantra seems to be you can only see things if you are there, and the less you see the less you know. I've met folks who were genuinely pissed off that they were asked to leave the hospital after a shift that put them up to the 80 hour max because an interesting procedure was about to start. So yes, they are probably not as good doctors at the end of their shifts, and the learning may be marginal, but a marginal view of a procedure that you have not yet been exposed to might be better than no exposure at all. It's sort of like attending a course lecture but only picking up half of what is said -- it's still a good start for some.

 

[stiffany]

In England, measures are being taken to reduce the current work hour load of 56 hours down even further. However, even with the 80 hour work week here, you can work up to 80 hours and you're also allowed to work up to 30 consecutive hours at a time (24 is supposed to be for patient care and 6 for transferring care to other residents, following up with labwork, etcetera). You also have to have at least one 24 hour chunk of time off each week and there are rules (I think it's 12 hours?) about the break in between shifts.

I think a lot of our attitude about work hours comes from the culture of America which includes the mentality that you have to work till your dead in order to actually get anything accomplished. Other cultures don't feel the same way and in fact, only Japan works more hours than we do statistically speaking.

Medicine in this country has also been influenced by the original structure of medical programs, where aspiring doctors actually lived in dormitories connected to patient clinics and were expected to be there all of the time, with 12 hours off on Sunday. Indeed, this is the way that Johns Hopkins actually came about.

Finally, in my personal opinion, I think a lot of this has to do with gender (as an anthropology major in college with women's studies research, I usually think this about lots of things though ;-)). Traditionally, medicine has been very much a male dominated world. With the domain of family time and responsibility as decidedly female and the notion that the workplace was for male breadwinners, I think family life got shafted for physicians. As medicine has become more diverse and as our society has begun to value personal time and balance more generally, I think some of these attitudes are shifting. Maybe it is a sense of entitlement, but given the evidence that sleep deprivation kills patients and the fact that residency is still touted as a learning experience (as opposed to what some would argue it really is: a hazing ritual allowing for huge chunks of work to be performed for low pay), regulations should be in place allowing for reduced work hours. (There's a great study by a guy from Havard's Sleep and Work Hour research group showing that even at 66 hours of work each week, residents still make fatigue related mistakes, but less than those occurring at 80 hours).

 

[goinverted]

Thanks guys, great responses!

 

[Neuronix]

From a third year med student (actually MD/PhD in PhD after 6 months of clinics). After seeing the system first-hand, I've gotten much more adamant about these beliefs.

1. How do you feel about the 80 hour regulation?

It doesn't go far enough. The work week should be at 60 hours as an absolute maximum. Would you argue that the doctors in England, who work that as residents, are inferior by design? I know some who have tried to argue that point with me, but strangely enough, there doesn't seem to be higher rates of medical errors across the pond. Nah, instead, what I do often hear argued is that doctors in England don't make as much money as a result of not having as much cheap labor. That's what the work hours issue boils down to, money. I've seen this in action at my medical school. This is the first concern when people talk about increasing education at any level. Money. How would we keep our department in the black if we didn't have so much cheap resident labor? This is very clearly wrong. It's like a big pyramid scheme, with everyone justifying their minimum wage internships as "I'll get mine someday on someone else's back..."

Only by taking it down to a level where humans can get the 8-9 hours of sleep they need a night, can they learn and practice medicine fully. As sleep and family life are cut down, the ability to be a critical, thinking human being goes away. Sure, you become an automaton when you work more than that. Maybe that's what the American resident boils down to--an automaton going off of a huge flow chart for each patient. I had always hoped for better.

Medicine should always be a job, not your entire life.

2. How do you think they will affect resident learning abilitiy?

It will improve their ability to learn. Again, when you don't sleep enough, you don't learn as effectively and you can't process information properly. This has been shown over and over again. Somehow surgeons in other countries with relaxed work hours still become surgeons and still practice medicine just fine. They don't have more years to their training. What I suspect is that other countries don't push as much scut on their residents (see Panda's blog). You have to ask yourself, why is the resident spending 80 hours a week in the hospital? The IM residents spend 90% of their time doing paperwork. The surgery residents spend at least 50% of the time in the OR doing nothing except "observing" (nodding off). It's just gross inefficiency. More paid staff to help the residents with non-educational activity would lessen the resident work hours without cutting education. However, any staff would earn at least double what the resident earns. It comes back to money.

3. How do you feel it will affect malpractice?

It's hard to say. Cutting resident work hours has been shown to decrease medical errors. Some will try to argue that lack of continuity of care will hurt patients. This is just silly. Why have residents write page after page after page of notes if nobody reads them? Residents will hand off their patients to a competant team of NPs, and nothing will be lost. However, malpractice lawsuits are more tied to the patient's perception of the hospital or doctor than to the quality of the hospital or doctor. This is one of the money reasons why I suspect the financial incentive is not there to lower resident work hours. Sure, it would provide a better quality of care for patients, but it may not have a direct effect on malpractice.

4. Do you feel it will make the idea of becoming a doctor less overwhelming?

Not really. You could go into lifestyle friendly specialties then and you can still go into lifestyle friendly specialties now.

5. Do you think it will have an effect on the way older physicians view their replacements?

Some, but these are the same kind of elitist jackasses that I don't really care to listen to anyways.

6. Do you feel that the 80 hour limit will be adhered to or will it be taken more as a loose rule, and why?

It will be a loose rule as long as there is no whistleblower protection. As one poster already pointed out, the Hopkins EM resident who pointed out the IM infractions was fired from the program and had to go elsewhere to complete his residency. This is flat out wrong, but whistleblowers are not at all protected by our current system. This means that anyone who blows the whistle will be martyred, and could end up without a residency entirely.

Instead, it's well known that some hospitals put pressure on their residents to work more than 80 hours and just not report it. Then, they can say "It's not our fault they didn't report that they worked more than 80 hours! They just loved it here too much!" when behind doors the resident has to come in more than 80 hours. If the resident can't say with anonymity that this is going on, how will this stop?

To the pre-meds. There are plenty of residencies that work 40-60 hours/week on average. They aren't really in internal medicine unfortunately. So, vote with your feet. Show why IM used to be the most competitive specialty years ago and now is mostly filled by FMGs. Show that surgery is just too insane for anyone but the... insane. It's the only way they're going to get the message. Choices that won't make your five year old think you're a stranger (as happened to a surgery resident here) include (in no particular order and not all inclusive): Pathology, Dermatology, Radiology, Emergency Medicine, PM&R, Rad Onc, Psychiatry, and some more I'm forgetting.

 

[BooMed]

Wow, thanks! Nice to hear an opinion from someone "in the trenches"

 

[goinverted]

Thanks Neuronix, that was one of best posts so far.

 

[goinverted]

Anyone else want to put in their two cents?

 

[SoCuteMD]

I know most of us are just pre-meds, but if anyone knows this...I figure you probably don't get most of the holidays off, but do you get vacation time/sick time in residency? and can you expect to work around 80 hours throughout your residency, or do you end up working more when you're an intern and maybe less when you're high up on the residency heirarchy?

Most residencies have pretty limited sick time (I was looking them up on the AMA web site). The general consensus on sick days seems to be, "You better be at the hospital, or IN the hospital."

Some programs limit when you can take your vacation to particular rotations as well.

 

[SoCuteMD]

80/7 is 11.4 ... so, yeah, still not too terrible.

You guys are HILARIOUS! You don't actually get to MAKE your own schedule. You are told your schedule. Most people I talk to get one day off in 7 if they are really really lucky. The rules are one day off in....ummmm....I forget but it might be 10 days. In any case, it will go more like this:

Monday 6 am-6 pm
Tuesday 6 am-Wednesday noon (but usually expected to also attend noon conference, so make that 1 pm)
Thursday 6 am - 6 pm
Friday 6 am-6 pm
Saturday 6 AM - Sunday noon (no noon conference on weekends)
Monday off

yes, this is over 80 hours, but the rule is an 80 hour average over 4 weeks, and this person didn't get a day off in that 7 day period.

Do you have any clue what you feel like after a 12 hour shift of being on your feet/running/and doing mentally challenging work at the same time?

 

[8744]

While I don't know how much of a role the 80 hour work week plays in this, I've heard quite a few comments from older doctors that this current generation of young doctors has far more of an "entitlement" attitude than any preceding it, and that this tends to make them more resistant to go that extra mile they need to to become great physicians. Might be a baby boomer vs Gen Y conflict, but it seems to be an emerging theme.

The older doctors are as full of **** as the proverbial Christmas goose. It was a lot easier to practice medicine back in the days when they were residents. There were fewer interventions, the length of hospitalization for a typical patient was longer, and they didn't try to reanimate essentially dead patients and keep them going long past the time when they should have died.

This translated into a more stable patient census with fewer admissions resulting in more sleep while on call. Today the call nights when you get anything more than a catnap or two between admissions and pages from the floor are exceedingly rare. It also meant that there simply wasn't as much to do or as many tests and imaging results to follow. The kind of things we routinely treat today back then would result in a grave bedside consultation with the family followed by discharge to home for the inevitable death.

Not to mention that with increasing medical sophistication we routinely make the full court press on patients who would have been considered terminal twenty years ago. I don't object to this, by the way, but it does add to the workload.

So it may be true that the doctor who did his residency in the fifties spent every other day in-house but he also probably got a decent night's sleep most of the time.

As for the boomer generation, collectively they are the most self-centered, egotistical generation in American history so all I can say is "wah."

 

[8744]

1. How do you feel about the 80 hour regulation?

Great. But it doesn't go far enough. A good night's sleep shouldn't be a privelege or something you go without every fourth day. Medicine is just a job. It's not the military where a 24-hour operational tempo is required. I'd like to see overnight call eliminated to be repalced by a shift system.

2. How do you think they will affect resident learning abilitiy?

I don't know. Are European resdients less well-trained with their shorter hours? One thing you need to realize is that a lot of your training time is absolutely wasted on scut and redundant paperwork. Seriously, if you can't train somebody in a specialty in 80 hours a week then there is something fundamentally wrong with your training methods. The problem is that residents have always been regarded as cheap labor for whom there was no overtime penalty. In the past there was no incentive to make training more eficient but maybe this will change.

3. How do you feel it will affect malpractice?

I have no idea.

4. Do you feel it will make the idea of becoming a doctor less overwhelming?

I didn't think about it when I applied to medical school but in hindsight I should have. Medicine is nice job but not if you're doing it 120 hours a week. Nothing is that much fun, even things that are fun.

5. Do you think it will have an effect on the way older physicians view their replacements?

Yes. But who cares?

6. Do you feel that the 80 hour limit will be adhered to or will it be taken more as a loose rule, and why?

It is very strictly adhered to. After an initial period of disbelief most programs realize that the RRC is serious and have taken appropriate measures. Will you sometimes go over? Sure you will. But if the program is sincerely trying to keep under the 80 hours its no big deal if you sometimes go over. Patient care does come first. It's not like the quitting bell rings and we drop our tools, union-like, and go home. There are some weeks (in some specialties) where you work less then eighty hours so while it may not average out over a month, it will over a year.