AAFP finally answers age long question: Do residents cost money to train?

[dutchman]

Apparently residents are actually saving hospitals mucha dinero

http://www.aafp.org/online/en/home/...ident-student-focus/20090702acgme-tstmny.html

Family Medicine Leaders Urge ACGME to Resist Call for More Limits on Residents' Duty Hours
"The testimony from Epperly -- who also is program director and CEO of the Family Medicine Residency of Idaho -- and others came in response to recommendations contained in a report released by the Institute of Medicine, or IOM, in December 2008. In the report, the IOM recommended that continuous on-site duty periods for residents not exceed 16 hours unless a five-hour uninterrupted sleep period is provided between 10 p.m. and 8 a.m.
Other recommendations in the IOM report, "Resident Duty Hours: Enhancing Sleep, Supervision and Safety," proposed reducing residents' workloads and increasing the number of days they would have off each month.
The IOM estimated that the cost of shifting resident work to other clinicians to comply with the proposed changes would be $1.7 billion a year. A later report from the nonprofit research organization RAND Corp. and the University of California, Los Angeles, estimated those costs at $1.6 billion a year."

If a slight work hour change like this is worth that much, I dont want to imagine how much the whole enchilada is bringing in. If I am not mistaken, the last time $$$ was used to justify inhumane treatment was during the fight to abolish slavery.

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[Law2Doc]

...If I am not mistaken, the last time $$$ was used to justify inhumane treatment was during the fight to abolish slavery.

Dude, unlike slavery, nobody is forcing you to become a resident. You know the deal going in -- it's long hours for almost no pay for X years. You can say, "no this is a bad deal for me" and opt not to go into the match. Nobody will mind. Nobody will whip you or lynch you or whatever they do to slaves. They will all wish you well on your new career choice.

And it's hardly inhumane. The human body can sustain far worse. Heck the generations before the 80 hour work week sustained far worse. I think most of us who are working at or close to this 80 hour figure would tell you it's totally doable. It's hard on outside of hospital relationships, it's hard on social life, it's hard on sleeping patterns, it's hard on commuting safely home afterwards. But you function surprisingly well during your shift, and you learn a ton. Now, the 30 hour shift is something I think a lot of folks might be willing to say is the area where the envelope is being unnecessarily pushed. Even that isn't "inhumane" per se but I think that a lot of programs have shown that with use of night float you can reallocate the same 80 hour/week manpower to avoid the need for these long shifts.

I think you demean and insult the whole history of slavery by comparing residency, a voluntary path where folks get to work in a nice clean safe environment for 80 hours per week, nobody gets whipped, nobody isn't allowed to quit, etc. Next you will be calling it a concentration camp. It isn't. It's a rough first job for a lot of folks, but it's really not SO bad. Everyone gets through it. And you learn a lot, see a lot, which is kind of the point.

 

[mig26x]

I almost never believe on the statement " If X and Y did it years ago why cant you do it now". Too many variables in the equations. Yes, doctors in the 60's-90's had it difficult with the 100 hours limit but these are different times. People are sicker (problem list of 7-10 problems with 10-15 meds), there's more patient, there's more pressure from health insurance to kick somebody out of the hospital in 2-3 days instead of 5 days, more legal responsability (even case managers are up your a## telling you who should be in the hospital and not or if they are observation vs inpatient) etc etc etc.

so yes, they did work 100 hours but I think what we are putting in 80 hours is almost equivalent to what they did on those 100 hours given the fact mentioned above.

And now comes 40 MILLION more non-insured patients to the medical care scene!!

 

[J ROD]

80hr is fine...seems about right.

30hrs straight with no sleep....dont make sense..why have sleep deprived people saving lives....

not to mention we all know folks need sleep....hell, the slaves even got sleep everyday.....

I think a 16-18hr shift should be the max.....I think that is the main problem that needs to be addressed.

 

[Winged Scapula]

I almost never believe on the statement " If X and Y did it years ago why cant you do it now". Too many variables in the equations. Yes, doctors in the 60's-90's had it difficult with the 100 hours limit but these are different times. People are sicker (problem list of 7-10 problems with 10-15 meds), there's more patient, there's more pressure from health insurance to kick somebody out of the hospital in 2-3 days instead of 5 days, more legal responsability (even case managers are up your a## telling you who should be in the hospital and not or if they are observation vs inpatient) etc etc etc.

so yes, they did work 100 hours but I think what we are putting in 80 hours is almost equivalent to what they did on those 100 hours given the fact mentioned above.

And now comes 40 MILLION more non-insured patients to the medical care scene!!

That's a popular refrain from current residents. But you've neglected to realize that work hour reforms are relatively new and that many programs are still not in compliance.

Are patients sicker now than they were in the 60s? Yes. The current patients in the ICUs would have been dead a generation ago. But work hour reform didn't happen in the "90s". It was less than 7 years ago and believe me, patients were still on 10-15 meds, with lengthy problem lists, etc. just a few short years ago when we routinely worked over 100 hours per week. And we didn't have all the mid-level help that is available at many hospitals now.

We all worked hard and there's no doubt that residency is difficult, regardless of when and where you're doing it. But let's please stop imaging that the current crop of residents are the hardest working residents alive when there are some young attendings around who worked just as hard, if not harder than you. I'd recommend going to your new MICU attending and telling him how easy he had it when he was a resident at the early part of this century, how much harder you're working and see what he thinks about that.

 

[mig26x]

That's a popular refrain from current residents. But you've neglected to realize that work hour reforms are relatively new and that many programs are still not in compliance.

Are patients sicker now than they were in the 60s? Yes. The current patients in the ICUs would have been dead a generation ago. But work hour reform didn't happen in the "90s". It was less than 7 years ago and believe me, patients were still on 10-15 meds, with lengthy problem lists, etc. just a few short years ago when we routinely worked over 100 hours per week. And we didn't have all the mid-level help that is available at many hospitals now.

We all worked hard and there's no doubt that residency is difficult, regardless of when and where you're doing it. But let's please stop imaging that the current crop of residents are the hardest working residents alive when there are some young attendings around who worked just as hard, if not harder than you. I'd recommend going to your new MICU attending and telling him how easy he had it when he was a resident at the early part of this century, how much harder you're working and see what he thinks about that.

unfortunately every generation thinks his/her generation is the hardest working generation ever. So this debates about who had it worse, 120 hr vs 100 hr vs 80 hours is absurd. I think that was the main point of my presentation.

And yes, I dont have to ask my MICU attending about this as they already make fun of it and they let us know how "pu$$y" we are with the 80 hours thing, LOL.

 

[michaelrack]

The current patients in the ICUs would have been dead a generation ago. But work hour reform didn't happen in the "90s". It was less than 7 years ago and believe me, patients were still on 10-15 meds, with lengthy problem lists, etc. just a few short years ago when we routinely worked over 100 hours per week. And we didn't have all the mid-level help that is available at many hospitals now.

.

If you guys think working 30 hrs straight is tough, try working 33-34 hours (occasionally up to 36 hours) straight, which I often had to do during residency. Those extra several hours can be torture.

 

[Winged Scapula]

unfortunately every generation thinks his/her generation is the hardest working generation ever. So this debates about who had it worse, 120 hr vs 100 hr vs 80 hours is absurd. I think that was the main point of my presentation.

Yes, it is and it was (is absurd and was the point of your post). Didn't mean to single you out as not understanding but there are a lot of others who really do think the days of long hours sitting around eating donuts while watching your post-op appy on day 7 was just a few years ago and that only they know what it is to work hard.

And yes, I dont have to ask my MICU attending about this as they already make fun of it and they let us know how "pu$$y" we are with the 80 hours thing, LOL.

If it makes you feel any better, my attendings said the same thing about us when we weren't q2 call and actually left the hospital.

 

[dutchman]

Dude, unlike slavery, nobody is forcing you to become a resident. You know the deal going in -- it's long hours for almost no pay for X years. You can say, "no this is a bad deal for me" and opt not to go into the match. Nobody will mind. Nobody will whip you or lynch you or whatever they do to slaves. They will all wish you well on your new career choice.

And it's hardly inhumane. The human body can sustain far worse. Heck the generations before the 80 hour work week sustained far worse. I think most of us who are working at or close to this 80 hour figure would tell you it's totally doable. It's hard on outside of hospital relationships, it's hard on social life, it's hard on sleeping patterns, it's hard on commuting safely home afterwards. But you function surprisingly well during your shift, and you learn a ton. Now, the 30 hour shift is something I think a lot of folks might be willing to say is the area where the envelope is being unnecessarily pushed. Even that isn't "inhumane" per se but I think that a lot of programs have shown that with use of night float you can reallocate the same 80 hour/week manpower to avoid the need for these long shifts.

I think you demean and insult the whole history of slavery by comparing residency, a voluntary path where folks get to work in a nice clean safe environment for 80 hours per week, nobody gets whipped, nobody isn't allowed to quit, etc. Next you will be calling it a concentration camp. It isn't. It's a rough first job for a lot of folks, but it's really not SO bad. Everyone gets through it. And you learn a lot, see a lot, which is kind of the point.

I don't understand where you are heading with this argument. My point is that residents are providing a service of huge value. Saving the hospitals astronomical amounts of money. You can at least acknowledge the fact that the folks arguing that residents are some financial burden are lying.

Now, as far as your quest to paint residency training as some happy-go-lucky choice residents can make or not make, I will pretend you are refering to residencies outside the united states, or to residents without debt.

 

[Moonglow]

If it makes you feel any better, my attendings said the same thing about us when we weren't q2 call and actually left the hospital.

You could leave the hospital?

 

[Buzz Me]

If you guys think working 30 hrs straight is tough, try working 33-34 hours (occasionally up to 36 hours) straight, which I often had to do during residency. Those extra several hours can be torture.

I just worked a 36-hour shift last week! Twice.

 

[DadofDr2B]

Residents were limited to 120 hours in 2004. Some were farmed out for a profit to smaller hospital to make the bigger hospital a profit. It is and was a form monopolistic behavior by the NIH and the collusion of the teaching hospitals that keeps wages down. Further, there is no collective bargaining to offset the one contract fits all situation and the bad working conditions.

JMO>

 

[staylor21]

I don't understand where you are heading with this argument. My point is that residents are providing a service of huge value. Saving the hospitals astronomical amounts of money. You can at least acknowledge the fact that the folks arguing that residents are some financial burden are lying.

It seems to me to be more complicated than what you state.

Take the extremes. A day 1 intern (PGY-1), or day 1 anesthesia resident (CA-1), or day 1 derm resident, etc probably costs the institution money--let's face it, they don't know a whole lot.

Now, consider a medicine resident/anesthesia resident/derm resident on the last day of their residency. Clearly, they're at an attending level (since the next day they will be attendings), but the hospital is getting their services for the price of a resident--so this is a good deal for the hospital.

At some point, the day 1 intern crosses over and becomes the last day of residency resident. That's the point at which the hospital starts to benefit financially from the resident. So whether, on the whole, the hospitla benefits financially from the resident depends on how steep the learning curve is.

 

[dutchman]

It seems to me to be more complicated than what you state.

Take the extremes. A day 1 intern (PGY-1), or day 1 anesthesia resident (CA-1), or day 1 derm resident, etc probably costs the institution money--let's face it, they don't know a whole lot.

Now, consider a medicine resident/anesthesia resident/derm resident on the last day of their residency. Clearly, they're at an attending level (since the next day they will be attendings), but the hospital is getting their services for the price of a resident--so this is a good deal for the hospital.

At some point, the day 1 intern crosses over and becomes the last day of residency resident. That's the point at which the hospital starts to benefit financially from the resident. So whether, on the whole, the hospitla benefits financially from the resident depends on how steep the learning curve is.

This argument can be made for all jobs using the on-the-job training model. The only difference is, depending on the nature of the argument, residents are painted as liabilities or assets . That is dishonest IMO. Residents provide valuable services, and residency programs provide valuable training. Neither party needs to lie about the value of the other for cheesy gain.

 

[Integrity]

Dude, unlike slavery, nobody is forcing you to become a resident. You know the deal going in -- it's long hours for almost no pay for X years.

Yeah, you are right. It is actually more like: if you want to pick cotton, you have to find a farm owner who will whip you for xxx years, because it just happens to be so that he is entitled to it, and the only way to be allowed independent cotton picking in the U.S, is to undergo slavery. But you are of course, free to do so.

Why are nobody in the land of freedom outraged that somebody has gotten the privilege to "own" a profession?

The whole pseudomoral discussion of how little or how much you actually work is a side-step of the real fact: Residency hours aren't determined according to a free market situation, and in the U.S, unreasonable amount of power is given to the hospital-side of the equation.