80 hours a week during residency

[rescuerdave]

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Have any of you seen this to reallybe true, that residents can only work a maximum of 80 hours? I have heard conflicting information from some friends. Some say that this doesn't include educational hours so it's totally crap. Others have told me that the hospitals have started to hire mor PAs and NPs to cover the administrative junk and the docs are just doing medicine.

 

[Andrew_Doan]

Originally posted by rescuerdave
Have any of you seen this to reallybe true, that residents can only work a maximum of 80 hours? I have heard conflicting information from some friends. Some say that this doesn't include educational hours so it's totally crap. Others have told me that the hospitals have started to hire mor PAs and NPs to cover the administrative junk and the docs are just doing medicine.

Programs are looking at this seriously. Iowa has already made changes. If programs don't and some one files a complaint, the program could be fined, put on probation, and/or lose accreditation.

 

[Jim Picotte]

The surgery program here has been in compliance since January. It is a big deal and the ACGME and AMA are getting really worried about having Federal legislation with teeth come out that they are going to be very strict on this issue. There is still a bill that hasn't yet been voted on in the House that has even stricter rules than the AMA and ACGME rules. As physicians, we have enough government oversight and just don't need any more. If we can't honestly take care of the problem ourselves and keep the work hours to less than 80 there is a huge problem and the government will eventually make us do it. While a lot of people are saying this isn't serious, how are they going to enforce it and don't believe it will really happen will find there program gone and losing the accrediation if changes aren't done. All it takes is one concerned resident from say radiology, pathology to ask the ACGME to look at how many hours the residents are working in surgery to get in trouble.

Oh the 80 hours DOES include lecture time and education. The downside is that it screws up moonlighting for a lot of places and home call does not count (every hour where you are called into the hospital does count though).

 

[DW]

is there a possiblity that some residencies might be lengthened to compensate for whatever might be "lost" in those 80 hour work weeks for specialities that are known for long hours (like neurosurgery for example)?

 

[Jim Picotte]

I can't answer that. That will be up to the board that grants the certification for the neurosurgeons which I'm not familiar with. They're the organization that decides what needs to be done in order to be competent neurosurgeon. It certainly could happen but I don't really think it needs to. I don't really think you'll be losing much by going to 80 hours a week and hopefully will have more quality in your education. The reasons for the work hours are not necessarily for education. Us residents get paid the same amount whether we work 40 hours or 120 hours a week. PA's and NP cost twice as much as each resident and they don't do the hours we do. Medicine is still a business.

 

[southerndoc]

The residency programs where I'm at are taking the 80-hour workweek rule very seriously. In fact, most programs are following a strict 80-hour workweek as opposed to 80 hours averaged over 4 weeks. I've heard a rumor of a surgery resident who was sent home on a Thursday afternoon because his 80 hours was up.

There is a rumor that next year my school will be adopting an 80 hour workweek for students. That 80 hours will include study time budgeted at around 10-15 hours per week for independent study. Too bad we didn't have something like that for my class!

 

[smackdaddy]

Originally posted by DW
is there a possiblity that some residencies might be lengthened to compensate for whatever might be "lost" in those 80 hour work weeks for specialities that are known for long hours (like neurosurgery for example)?

it is being considered right now.
afaik, no specialty has announced that they are lengthening their training programs as a result of the 80hr decisions.

 

[ckplay]

Originally posted by DW
is there a possiblity that some residencies might be lengthened to compensate for whatever might be "lost" in those 80 hour work weeks for specialities that are known for long hours (like neurosurgery for example)?

Residency in general is long enough and the length is somewhat arbitrary. I don't think programs are interested in lengthening residency training unless Medicare is willing to pay for it. For most programs the concern with the new ACGME rules is cross-coverage, not whether their residents are getting adequate training.

 

[triathlete411]

I am vehemently against this arbitrary 80 hour work week thing for several reasons. The one reason that I think everyone could and should support, whether they are proponents or opponents of these new regulations, is that the rules are being constructed by people who have no idea what really is involved in the education of America's doctors. I think we as students, residents, and young physicians, need to stand up and legislate ourselves before this gets out of hand.

If anyone knows how I might get involved in this in a more serious capacity (as opposed to posting on forums), please pass on that information.

Thanks!

 

[Andrew_Doan]

triathlete411,

The laws were made to protect patients and ensure quality of care. I have to say that 80 hours per week is a good thing. It's really hard to learn and concentrate if you're working 80-100+ hours a week.

The reason why this law was introduced first in NY and then as a federal law is because there was evidence that patient care was suffering. I don't know the full details, but the death of a young girl was the result of tired interns/residents who didn't want to check on a patient's complaint during a busy call night. They kept ordering meds to "calm" her down over the phone. In the morning, this young lady was found dead. A physician never laid eyes on her.

Triathlete411, have you worked more than 80-100+ hours/week? Being a resident, I know how this feels and working more does not contribute or equate to more learning. Working under 80 hours/week allows me to be mentally sharp and time to read. Residents who work long hours rarely touch a book or can stay awake during conferences. Working super long hours is detrimental to physician-education in the long run.

 

[Brewster]

Originally posted by triathlete411
is that the rules are being constructed by people who have no idea what really is involved in the education of America's doctors.

Actually, the most recent rules were put forth by the ACGME.

Also, I believe the case in New York was one where a patient who was on an MAOI was given Demerol by an intern and subsequently died.

 

[smackdaddy]

how many calls have you been on where you get zero hours of sleep? esp after the first few, i would bet that while people say they were working 80-100 hours a week, the actual # of work hours is at least 10% less, and people stay up to watch tv or talk to their friends instead of sleeping.
and no one is saying anything about the quality of care patients receive when their attending physicians/private practice physicians 'work' those kind of hours.
residents education will be worsened because they don't have continuity in their patient care. everything these days already is shifted to-hey that's an outpatient problem, they can work it up in the clinic. and nobody actually learns how to take care of these problems. people won't know whether their diagnoses were correct or their management or how patients fared because they were just admitting for the night.
lastly, how many mistakes will be made becuase of transitional (sign-out) problems?

 

[rescuerdave]

I appreciate all the responses and think this is a great thread. Clearly there is many differeing opinions on the issue. I think the important thing is that docs make there voices heard on legislative issues and even lobby for legislation to ensure good medicine. My brother-in-law is a neurosurgeon in mississippi which needs major tort reform. The malpractice there has gotten completely out of control. They are working hard to try and change things, but he is still strongly considering moving because of the situation. This is so sad because its the pts that suffer, because to many individuals are sue happy because lawyers call them or place adds to get people to sue. I could go on forever so I will stop there and spare you the nightmare stories my brother-in-law has told me.

 

[ArrogantSurgeon]

Friends of mine who are residents in Europe and Australia are dismayed that residents in the U.S. will work *only* 80 hours per week, let alone 100+ hours. In those countries, surgical residents average about 60 hours per week, and some internal med residents do about 38-50 hours per week believe it or not. Plus, if they want to work more then they get paid time-and-a-half for overtime! So my question is how come residents in those countries work so few hours compared to residents in the U.S.??

 

[southerndoc]

Originally posted by ArrogantSurgeon
Friends of mine who are residents in Europe and Australia are dismayed that residents in the U.S. will work *only* 80 hours per week, let alone 100+ hours. In those countries, surgical residents average about 60 hours per week, and some internal med residents do about 38-50 hours per week believe it or not. Plus, if they want to work more then they get paid time-and-a-half for overtime! So my question is how come residents in those countries work so few hours compared to residents in the U.S.??

They also spend 6+ years before becoming consultants, too.

 

[ArrogantSurgeon]

Not really true that they spend more time in training Geek Medic. A friend of mine who is in Australia spent 2 years in general surgery training, 4 years in what they call "advanced surgery training" (which is just more years in general surgery residency with greater responsibility), and 3 years in a pediatric surg fellowship...all in Australia and some in the Netherlands. So in essence he trained 9 years after med school to become a pediatric surgery consultant.

Now in the U.S. we do 5 years of general surgery residency plus 2-3 years in a fellowship if we want to be a subspecialiast surgeon (CT, vascular, pediatric, etc). This is not including the 1-2 additional years of research that you are almost obligated to do if you want a competetive fellowship. So in the end it is roughly the same in the amount of years. Yet those residents are working far less hours than their American counterparts during those years.

I don't know, maybe the ancilliary support in those countries is VERY good so that residents aren't wasting their time with non-essential duties??

 

[njbmd]

Originally posted by rescuerdave
Have any of you seen this to reallybe true, that residents can only work a maximum of 80 hours? I have heard conflicting information from some friends. Some say that this doesn't include educational hours so it's totally crap. Others have told me that the hospitals have started to hire mor PAs and NPs to cover the administrative junk and the docs are just doing medicine.

Hi there,
At my program, we are in compliance and have been since January with the rare exception of an illness or personal emergency. Even before my institution started the 80-hour rule and on rotations where I was in the hospital 140 hours per week, I wasn't working all of those hours. I was sleeping and studying in my call room but I wasn't working a straight 140 hours.

My program did not hire any additional PAs or NPs to cover administrative tasks. The interns were required to make sure all of the work was done. We became more efficient at things like dictating op reports and discharge summaries. If I had a break in action, I would pre-dictate patients that I was sure to be discharged. I also learned to see patients in clinic, dictate and keep up with orders, studies and the like.

What did get "swatted" was some of my OR time. As a surgical intern, OR time is golden and what you do the floor stuff for. I often lost the opportunity to scrub in on cases after my work was done because my hours were used and I needed to leave the hospital. On some very busy services like vascular surgery or cardiothoracic surgery, you won't get any OR time as an intern because you are so busy getting patients in and out of the hospital. For those rotations, I really enjoyed the old system with more hours.

njbmd

 

[southerndoc]

Originally posted by ArrogantSurgeon
Not really true that they spend more time in training Geek Medic. A friend of mine who is in Australia spent 2 years in general surgery training, 4 years in what they call "advanced surgery training" (which is just more years in general surgery residency with greater responsibility), and 3 years in a pediatric surg fellowship...all in Australia and some in the Netherlands. So in essence he trained 9 years after med school to become a pediatric surgery consultant.

So your friend spent 6 years training for general surgery, while US residents spend only 5 years. That probably evens out the playing field for the reduced hours during the Aussie residency. Most of the UK consultants spend more time in training than their US counterparts. Whether this is beneficial or not remains to be seen.

Ancillary staff overseas can vary significantly. At least in the UK where I was for a few months (doing an independent study of the National Health Service), nurses there were quite good, but were limited in their scope of practice. For instance, administration of narcotics by nurses was strictly forbidden. The physician himself had to administer the narcotic.

 

[AlexanderJ]

How will the 80 hr work week affect moonlighting?

 

[edfig99]

Originally posted by AlexanderJ
How will the 80 hr work week affect moonlighting?

from the ACGME website (acgme.org):

"Moonlighting that occurs within the residency program and/or the sponsoring institution or the non-hospital sponsor's primary clinical site(s), ie, internal moonlighting, must be counted toward the 80-hour weekly limit on duty hours. "

 

[Annette]

Originally posted by smackdaddy
how many calls have you been on where you get zero hours of sleep? esp after the first few, i would bet that while people say they were working 80-100 hours a week, the actual # of work hours is at least 10% less, and people stay up to watch tv or talk to their friends instead of sleeping.
and no one is saying anything about the quality of care patients receive when their attending physicians/private practice physicians 'work' those kind of hours.
residents education will be worsened because they don't have continuity in their patient care. everything these days already is shifted to-hey that's an outpatient problem, they can work it up in the clinic. and nobody actually learns how to take care of these problems. people won't know whether their diagnoses were correct or their management or how patients fared because they were just admitting for the night.
lastly, how many mistakes will be made becuase of transitional (sign-out) problems?

Most non-surgical attendings don't work over 80 hours a week. I'd be surprised if surgical attendings did much over 80. And even though you do have some time to sleep/study/ do nothing, you are on a short leash. Doing nothing can be just as stressfull as having work to do because you can be called at any time.

FAA regulates how long flight crews can work, even truck drivers are limited as to how long they can work. Why? So they don't end up killing people due to being over-tired. Patients are put at risk so that we can learn, but they shouldn't be put at risk just because we are tired.

You should be seeing different diseases at various stages, in various settings (including outpatient clinics!). If you aren't, then your training is seriously lacking. If you have a patient with a rare disease, or if you are particularly concerned about how your treatment worked, you can always follow up on the patient.

Sign-out troubles? What a weak argument for working more hours. Maybe the troubles are secondary to residents being too tired to sign out properly?

As for OR time, I feel for you. However, it isn't a legitimate argument to let every resident work over 80 hours. Also, since OR time is so integral to training in surgery programs, the programs should find a way to reduce the amount of time outside the OR, not in it. I'm certain I wouldn't want to be the patient of a surgery resident who has just worked the past 36 hours straight at the end of a 100 hour work week.

 

[smackdaddy]

most people who finish training go into private practice and are not attendings, per se, just practitioners who work more than 80 hours per week. most people receive care from these practitioners. and you are naive if you think that most non surgical attendings don't put in 80 hour weeks if you include their call responsibilities, research, writing, time preparing lectures, and reviewing other articles.

you may think the sign out argument is weak, but it is a fact of life. residents on light rotations do crappy sign outs too. if you are worried about hurting your patients, and you accept the fact that crappy sign outs occur regardless of the # of hours worked, then you should favor reducing the # of signouts. with all the day floats and night floats occurring, i think it is inevitable patient harm will occur--moreso than the current system where most interns have resident redundant coverage. you may disagree, no biggie.

you may also think residends follow up on patients but they don't follow up the majority, and certainly not months later when the work up is finally done. especially when the disease is not a special unique case. i'm sure they will learn how to do it eventually but i was under the impression that's what residency was for.

you sound like someone who has a very idealized view of medicine. it will be interesting to see your view 5 years from now.

 

[MacGyver]

smackdaddy,

for that matter why not work 140 hours a week straight?


apparently you think it wouldnt hurt patients at all so why not?

Just think! If you worked 140 hours a week straight thats less than one sign out per week! Think of all the mistakes that will be avoided because you wont have to dump patients on other residents coming in for shift changes!

 

[Scrubbs]

Originally posted by AlexanderJ
How will the 80 hr work week affect moonlighting?

On the residency trail, several PD's told me that their approval was needed for ALL moonlighting (both internal and external), and that it would be counted towards your 80hr week. Anyone else heard the same or different?

 

[droliver]

I asked our PD about this moonlighting issue.... Contrary to what I thought previously, he said that moonlighting is going to be considered part of your work hours by the RRC & is likely going to be limited a great deal in the future for all specialties due to medical-legal liability for the training programs

 

[smackdaddy]

Originally posted by MacGyver
smackdaddy,

for that matter why not work 140 hours a week straight?


apparently you think it wouldnt hurt patients at all so why not?

Just think! If you worked 140 hours a week straight thats less than one sign out per week! Think of all the mistakes that will be avoided because you wont have to dump patients on other residents coming in for shift changes!

why not? i think going towards 140 is certainly better than going towards 80. i recognize i'm in the minority, but most of the residents i see spend more time surfing on the internet than sleeping. or figuring out what house/car/vacation they want next. which is fine with me, i just want to clarify that 80 hours at work does not necessarily equate with working 80 hours.