80hr rule change?

[Dr JPH]

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I have actually never ran into a resident who consistently pulled 80 hours a week. In fact unless they were on weekend call even the surgery residents I met pull around 60-65 hours a week of official work. Only people I have met who consistently pulled 80 hours were interns.

You havent been around many surgery residents then!

 

[Critical Mass]

Bear in mind that many programs won't allow you to moonlight, or if they do, it counts towards your 80 hours, so your moonlighting time is very limited. That is, unless you're in the lab. There you can moonlight quite a bit.

True. True. No moonlighting = bottom of my rank list.

The sooner that I get this crap paid off, the sooner I can move on to something that I might enjoy.

 

[Trismegistus4]

Sort of. A lot of business, law and accounting jobs evaluate their employees and have expectations based on billable hours or revenues generated. You are as good as the money you generate, and you generate money by billing clients by your time spent working. Thus while you are correct that eg law is a salary job, if you aren't billing over, eg, your 2500 hours/yr "requirement", you won't be taking any vacation, getting any bonus or staying long at the firm. (Usually on average you can bill about 2 hours for every three you are in the office.) So a lot of people who had real jobs in fact are coming from environments where it was expected that you logged a specific number of hours.

I'm aware of that. What I was trying to get across was that these aren't "hours-based" jobs, i.e., jobs where you punch a clock and get paid by the hour. It sometimes seems like people on SDN think of all work as clock-punching work.

Well, boo hoo for them. If they hadn't continued to gleefully exploit residents by dumping maximal work on them when it was glaringly obvious that being in the hospital for 100 hours a week in 2000 was absolutely nothing like being in the hospital for 100 hours in 1980 then none of this would have happened. It was THEIR failure to adjust the "assigned work" to something that human beings are capable of handling safely that led to the outside imposition of hourly maximums (since obviously regulators cannot adjust how much work you are assigned).

Good point. However, I don't think the solution is to complain to those same outside agencies that they aren't pulling the reins on our evil overlords hard enough.

 

[Dr JPH]

True. True. No moonlighting = bottom of my rank list.

The sooner that I get this crap paid off, the sooner I can move on to something that I might enjoy.

Paying your loans off faster may not be the best financial decision. Depends on your interest rate, tax breaks and overall amount of debt.

For me a 30 year payoff works out the best financially. With my interest rates it would be crazy to pay off quicker.

 

[Doctor Bagel]

Well, boo hoo for them. If they hadn't continued to gleefully exploit residents by dumping maximal work on them when it was glaringly obvious that being in the hospital for 100 hours a week in 2000 was absolutely nothing like being in the hospital for 100 hours in 1980 then none of this would have happened. It was THEIR failure to adjust the "assigned work" to something that human beings are capable of handling safely that led to the outside imposition of hourly maximums (since obviously regulators cannot adjust how much work you are assigned).

👍 I also think it's much better for my psyche to define myself first as a person and second (or third or fourth or fifth) as whatever I happen to do for a living. Consequently, I don't think the end times are upon us when doctors think of themselves as employees. These old school docs probably have horrible marriages, kids that hate them, no hobbies and no friends. All they've got is being a doctor. How pathetic is that.

 

[Dr JPH]

These old school docs probably have horrible marriages, kids that hate them, no hobbies and no friends. All they've got is being a doctor. How pathetic is that.

Now theres a gross generalization for you. 🙄

 

[Guile]

Well, boo hoo for them. If they hadn't continued to gleefully exploit residents by dumping maximal work on them when it was glaringly obvious that being in the hospital for 100 hours a week in 2000 was absolutely nothing like being in the hospital for 100 hours in 1980 then none of this would have happened. It was THEIR failure to adjust the "assigned work" to something that human beings are capable of handling safely that led to the outside imposition of hourly maximums (since obviously regulators cannot adjust how much work you are assigned).

Actually this is false. It wasn't the result of "old school physicians" not "adjusting the work-load." The 80-hr rule stemmed from one case in NY 1989 where a LAWYER'S daughter was given Demerol and haloperidol and died as a result. Sure it was a medical error and a tragic end to what should have been a successful hospital course, but these things still happen even post-80-hour rule.

Wouldn't you know it that a lawyer would be involved in this somehow?

 

[Guile]

I'm aware of that. What I was trying to get across was that these aren't "hours-based" jobs, i.e., jobs where you punch a clock and get paid by the hour. It sometimes seems like people on SDN think of all work as clock-punching work.


Good point. However, I don't think the solution is to complain to those same outside agencies that they aren't pulling the reins on our evil overlords hard enough.

Unless you're an EM doctor. 🙄

 

[Dr JPH]

Bell I think the name was. I could be wrong.

 

[Doctor Bagel]

Now theres a gross generalization for you. 🙄

Maybe. But I don't see how one could have a successful life outside of work if they always prioritized work over everything else. Well unless they're surrounded by saints. I still stand by my assertion that the notion that one should be a doctor first isn't a healthy notion. I guess I'm not a fan of cultish ideas about being a doctor.

 

[JohnnyOU]

Maybe. But I don't see how one could have a successful life outside of work if they always prioritized work over everything else. Well unless they're surrounded by saints. I still stand by my assertion that the notion that one should be a doctor first isn't a healthy notion. I guess I'm not a fan of cultish ideas about being a doctor.

Almost everything Bagel-Babe says is correct cuz she's cute 😉

Heck, if I wasn't gay I'd...oh wait.. 😀

 

[Guile]

Bell I think the name was. I could be wrong.

Libby Zion was the girl who died.

 

[Dr JPH]

Libby Zion was the girl who died.

Damnit JP, wrong again! 😀

 

[Law2Doc]

Actually this is false. It wasn't the result of "old school physicians" not "adjusting the work-load." The 80-hr rule stemmed from one case in NY 1989 where a LAWYER'S daughter was given Demerol and haloperidol and died as a result. Sure it was a medical error and a tragic end to what should have been a successful hospital course, but these things still happen even post-80-hour rule.

Wouldn't you know it that a lawyer would be involved in this somehow?

Um no, it was the daughter of a well published NY journalist, who had long since given up the practice of law like 20 years earlier (he was a former prosecutor). I'm not sure you can blame the lawyer as much as the media on this one.

 

[Guile]

Um no, it was the daughter of a well published NY journalist, who had long since given up the practice of law like 20 years earlier (he was a former prosecutor). I'm not sure you can blame the lawyer as much as the media on this one.

Sorry, the article I read just called him a "lawyer," and didn't give any background.

 

[dilated]

Actually this is false. It wasn't the result of "old school physicians" not "adjusting the work-load." The 80-hr rule stemmed from one case in NY 1989 where a LAWYER'S daughter was given Demerol and haloperidol and died as a result. Sure it was a medical error and a tragic end to what should have been a successful hospital course, but these things still happen even post-80-hour rule.

Wouldn't you know it that a lawyer would be involved in this somehow?

That's the 80 hour rule in New York State. The case was in 1984, the rule was instated in 1989. I think it's safe to say that the ACGME 80 hour rule instituted in 2003 was not, in fact, based on one case 20 years previously. It was a reflection of the fact that working 100 hours in a 2000 hospital is a hell of a lot harder and provides a lot less time for rest than 100 hours in a 1970 hospital, yet the hours residents were expected to work had not changed.

 

[Law2Doc]

That's the 80 hour rule in New York State. The case was in 1984, the rule was instated in 1989. I think it's safe to say that the ACGME 80 hour rule instituted in 2003 was not, in fact, based on one case 20 years previously. It was a reflection of the fact that working 100 hours in a 2000 hospital is a hell of a lot harder and provides a lot less time for rest than 100 hours in a 1970 hospital, yet the hours residents were expected to work had not changed.

I think it's conventional wisdom that the Zion case got this ball rolling. There was really no impetus or public clamoring for change before this.

 

[8744]

...That's really why the old-school docs hate the 80 hours restriction--not for the specific number of hours, but for the approach to the profession in general, the way of thinking about what it means to be a doctor, inculcates. If you listen to them, they complain a lot about younger med school grads considering medicine "shift-based work" and having an "employee mentality." Medicine was supposed to be about being an absolute top-level expert at diagnosing and treating disease, about doing whatever it takes to get a patient cured or healed or whatever. And it was that that gave medicine the clout, the power, the prestige (including the ability to demand high incomes) that it had...

I concur with the observation that the old school doctors are a bunch of whining, spoiled, ninnies. Boo friggin' hoo. Just because they got abused they feel like everyone should. Times change. Medicine has changed. The current system of residency training dates back to the turn of the last century and was institutionalized in the fifties, almost sixty years ago. Imagine bringing some residents from 1960 forward in time and let's see how they'd cope.

Additionally, medical training used to be almost the exclusive domain of geeky, single white guys living almost monastic lives with no outside famial or financial responsibilities. That's why an intern c. 1950 could get by on a stipend of 25 buck per month, living and eating as he did in the hospital.

I have a family and those old-school doctors who think I should sacrifice them to their dream of the Good Old Days can go **** themselves. It isn't even about patient care, either, because the mutant system of health care delivery that has evolved in teaching hospitals ensures that most of our time is wasted on meaningless adminstrative tasks.

I also have to point out again that medicine is not a cult. It's a business. There is not loyalty, no reward for taking one for the team, and no reason to sacrifice yourself for the profit of somebody else which is exactly what the hospital wants and would have you do except that those uppity residents won't stop complaining about being worked like Tortugan sugar plantation slaves.

The arrogance of the old school makes me want to burn the mother down. As if I'm going to let my kids grow up without me and my wife become a functional single-mother because some senior doctors can't figure out how to make the hospital more efficient.

Why, in the Good Old Days they could keep you in the hospital 120 hours out of a 168-hour week. That's 48 hours or a little more than six hours per day for sleep, personal time, hobbies, or other unimportant things like family.

 

[Dr JPH]

I concur with the observation that the old school doctors are a bunch of whining, spoiled, ninnies. Boo friggin' hoo. Just because they got abused they feel like everyone should. Times change. Medicine has changed. The current system of residency training dates back to the turn of the last century and was institutionalized in the fifties, almost sixty years ago. Imagine bringing some residents from 1960 forward in time and let's see how they'd cope.

Additionally, medical training used to be almost the exclusive domain of geeky, single white guys living almost monastic lives with no outside famial or financial responsibilities. That's why an intern c. 1950 could get by on a stipend of 25 buck per month, living and eating as he did in the hospital.

I have a family and those old-school doctors who think I should sacrifice them to their dream of the Good Old Days can go **** themselves. It isn't even about patient care, either, because the mutant system of health care delivery that has evolved in teaching hospitals ensures that most of our time is wasted on meaningless adminstrative tasks.

I also have to point out again that medicine is not a cult. It's a business. There is not loyalty, no reward for taking one for the team, and no reason to sacrifice yourself for the profit of somebody else which is exactly what the hospital wants and would have you do except that those uppity residents won't stop complaining about being worked like Tortugan sugar plantation slaves.

The arrogance of the old school makes me want to burn the mother down. As if I'm going to let my kids grow up without me and my wife become a functional single-mother because some senior doctors can't figure out how to make the hospital more efficient.

Why, in the Good Old Days they could keep you in the hospital 120 hours out of a 168-hour week. That's 48 hours or a little more than six hours per day for sleep, personal time, hobbies, or other unimportant things like family.

 

[45408]

Paying your loans off faster may not be the best financial decision. Depends on your interest rate, tax breaks and overall amount of debt.

For me a 30 year payoff works out the best financially. With my interest rates it would be crazy to pay off quicker.

The class that graduated 3-4 years ago had the pleasure of consolidating at just over 2% interest. Of course that makes sense to pay off at your leisure, but my loans aren't going to be anywhere near that dreamy level.

 

[Dr JPH]

The class that graduated 3-4 years ago had the pleasure of consolidating at just over 2% interest. Of course that makes sense to pay off at your leisure, but my loans aren't going to be anywhere near that dreamy level.

I consolidated most of my loans at just under 3%

But I do see your point.

At least Stafford loans are capped at 6.8% while in deferrment. Helps a little.

 

[45408]

I have worked 80 hours in a week. I'm not exactly going into medicine for the lavish lifestyle it affords me outside of work.

Wanting to have a life other than being in the hospital isn't exactly going into medicine for the lavish lifestyle.

 

[45408]

I consolidated most of my loans at just under 3%

But I do see your point.

At least Stafford loans are capped at 6.8% while in deferrment. Helps a little.

My interest rate in an FDIC-insured savings account is higher than your loan interest rate. You couldn't find a way to make less than 3% on your money elsewhere (except hiding it under your mattress), so obviously it's best for you to pay them off slowly.

 

[Guile]

I consolidated most of my loans at just under 3%

But I do see your point.

At least Stafford loans are capped at 6.8% while in deferrment. Helps a little.

Where did these rates come from? Staffords are at 6.8% and GradPLUS is 8.5%. You're graduating this year (according to your signature) so how are you getting rates so low?

 

[Tired]

Where did these rates come from? Staffords are at 6.8% and GradPLUS is 8.5%. You're graduating this year (according to your signature) so how are you getting rates so low?

Our loans weren't capped, and so were subject to interest rate adjustments. About two years ago the rate dropped as low as 2.75%, so lots of people consolidated at that time to lock in the lower rate. You can consolidate whenever you want, you don't have to wait to graduate.

 

[Critical Mass]

Paying your loans off faster may not be the best financial decision. Depends on your interest rate, tax breaks and overall amount of debt.

I consolidated my previous (UG/G) debt at 5% and have my med school stuff at 6.8%.

Still doesn't matter to me. The debt goes ASAP no ifs, ands, or buts. No pricetag on peace of mind.

BTW you can no longer consolidate under a federal program while in school. New rule this year. Rates are also fixed. My school just bought us lunch to go over new financial aid laws. Bottom line was that going private with them is nearly never a good idea. They also told me that the 6.8% rate (based on T-bill) won't likely change much this time around.

Sorry that I got us off topic. All I'm saying is that I'm taking whatever moonlighting opportunities I can get.

 

[Doctor Bagel]

Where did these rates come from? Staffords are at 6.8% and GradPLUS is 8.5%. You're graduating this year (according to your signature) so how are you getting rates so low?

I'm assuming that he either didn't borrow this year or he didn't include this year's loans in this consolidation. Yeah, those 3% interest rates are long, long gone. With those rates, I think JP is right that stringing the loans out is the best policy. I'm planning on dying still owing money on my law school loans. 😉

 

[raidermedic]

Wow, I've never met a surgery resident who was under the 80 hours/week. Where is this?

I guess I should have elaborated, Residents typically would come in around 5 or 6 AM to round. Cases would start around 7 AM, typically done with OR and ward duties by 5 pm. Although residents would typically stay late looking for cases but even then most surgeries are done by 7. Lecture/ABSITE review was typically at 5 pm. The program had a night float system so while residents always took home call for any post op pt only the night float resident was in house. Aside from interns residents would take 2-3 days of weekend call per month with two full weekends off per month.

So yes when they are doing their weekend call residents did hit the 80 hour limit. However on their weekend off weeks (which is basically every other week) they would log around 12 hours a day for five days. Leaving them well below the 80 hour mark. Trauma and transplant services had slightly different hours.

That said the case load at the program was very impressive. It's a relatively small program so there are plenty of cases to go around. Residents/interns operate from day one. Residents tell me there is pratically no scut work. The trade off I suppose is that this rotation as a medical student is a real bear.

 

[indo]

Didn't the girl in the Zion case have cocaine in her system?

 

[45408]

Didn't the girl in the Zion case have cocaine in her system?

A detail.

 

[Law2Doc]

Didn't the girl in the Zion case have cocaine in her system?

Yes, it was actually reportedly not the model case for sleep deprivation related medical mistakes. Unclear what the gal had taken before she started crashing. But her father, through his columns and journalism contacts, apparently had access to the major NY papers and "his" view of the matter was what made it into the public arena.

 

[deuist]

Yes, it was actually reportedly not the model case for sleep deprivation related medical mistakes. Unclear what the gal had taken before she started crashing. But her father, through his columns and journalism contacts, apparently had access to the major NY papers and "his" view of the matter was what made it into the public arena.

Good old journalism integrity.

 

[Dr JPH]

Where did these rates come from? Staffords are at 6.8% and GradPLUS is 8.5%. You're graduating this year (according to your signature) so how are you getting rates so low?

As another poster mentioned about 2 years ago we were able to consolidate while in school.

Unfortunately that was a one-time offer.

Anyone graduating in the last 3-4 years got really lucky with that.

I plan on paying off my higher interest rate loans and letting that 2.875% sit there for a long long time