AAMC is against resident work hrs legislation

[Homer J. Simpson]

Thought this would be of interest to some of you.

Personally, I think it's shameful that the AAMC would prefer to keep the status quo.

<a href="http://www.aamc.org/advocacy/corres/ed/conyers.htm" target="_blank">AAMC Opposes Resident Work Hours Legislation</a>

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[nyskindr]

It does not seem shocking to me that the AAMC opposes resident work hours legislation.The AAMC is there to protect the economic interests of its constituant hospitals and medical schools.Not the interests of sudents and residents.The less hours a resident works the more money it costs a hospital to hire other physicians or more likely technicians to perform scut and other such tasks.

 

[LR6SO4]

The AAMC is right on. Nothing has been done yet really on a national level (ie outside of NY) to limit resident hours. Why not try it first without passing new laws? Isn't that how laws should be made anyways? Maybe then we could get the moonlighting clause out too! I don't want the gov't telling me I can't work on my own time if I want to. By the way the AMA is against the bill as well. I'd like to see how Conyers plans on getting this passed, oh yeah, he's got AMSA on his side...big deal. This will die very soon.

 

[Jim Picotte]

I'm against the bill myself in its current form. The moonlighting issue is huge with me and even though I certainly think that programs should limit the work week to under 80 hours, I'm not a big fan of a new law that will try and do that.

 

[Tazdoc]

Hey Guys,

If you haven't done so already, take a little time to familiarize yourselves with the issue and this bill in an original thread entitled, <a href="http://www.studentdoctor.net/cgi-bin/ubbcgi/ultimatebb.cgi?ubb=get_topic&f=11&t=001028" target="_blank">AMSA and resident work hours</a> that I just "bumped" up from earlier. You should now see it near the top.....

Many of the positives and negatives were dealt with by LR6SO4, myself and many others

 

[dr.evil]

I'm not a big advocate of any "law" that would limit hours for residents. Although I won't enjoy 120 hour weeks, I find it difficult that an arbitrary number such as 80 hours has been thrown out there. So you're too tired to take care of your patients if you work 100 hours a week but not 80?

Limits to hours may increase the years needed to be a board certified whatever which will be very unpopular. Anyone game for a 5 year Internal Medicine residency? Didn't think so. This is probably stretching reality but ramifications may be adverse.

Just talking out of my butt. Laws won't be needed. Residencies who kill their residents should not go filled. That way, they must adjust to attract quality residents. I think this is actually starting to evolve like this in many general surgery programs.

 

[Homer J. Simpson]

Originally posted by LionTrees:
• I find it difficult that an arbitrary number such as 80 hours has been thrown out there. So you're too tired to take care of your patients if you work 100 hours a week but not 80?•••

There's always an element of arbitrariness in these things. You could make the same argument for airline pilots hours. They can't work more than 16 hours in a day. Could they have made the law 17 without any discernible difference? Of course. Same with DUI laws; you're OK to drive at .075 BAL, but not .08?

The line has to be drawn somewhere.

 

[Hopkins2010]

Homer,

I couldnt have said it any better myself.

 

[LR6SO4]

Liontrees, you just weren't talking out of your butt. Several surgery and ob/gyn residency directors have already talked of adding another year if it passes. In England they are planning on going down to 48 hours, plan is to have 6 yr primary care residencies and 10 for surgery. In our country that would really put us in a bad place financially, funding more years for residents plus hiring more ancillary staff so that more learning could go on in the hospital. I know that saving lives shouldn't be about money, but that is the state that our system is in so it will have to be dealt with.

 

[dr.evil]

Homer,
You're right. Arbitrariness is abound in much of medicine.

I just don't think laws should be needed. Medicine is a very self-governed entity and I hope it will stay that way (although this has become an increasing problem with our malpractice happy society).

There are a ton of residency programs out there. Some work ridiculous schedules while others are much more reasonable. If you are one of the ones who cannot stand the hours, go to a residency program where that is made more of a priority. There are many changes in schedules right now including night floats and going home post-call early, which have made substantial progress in resident hours. Those programs that do not adapt will be punished by going unmatched on match day (if the hours are truly as important to every single medical student as some would have you believe) and will have to adapt.

Evolution is a wonderful thing.

Much love to all...

 

[mpp]

Don'f forget about the safety concerns of an under-staffed hospital because the resident had to go home before the 81st hour in the week...

 

[Hopkins2010]

Originally posted by mpp:
•Don'f forget about the safety concerns of an under-staffed hospital because the resident had to go home before the 81st hour in the week...•••

Using that line of logic, you could also argue that its a safety IMPERATIVE to mandate all residents to 48 hour shifts and 130 hour work weeks in the name of safety.

Of course, my opinion is that you get virtually NO safety advantage past a certain number of hours per week. After all, if you are dead tired you arent going to be too keen at picking up medical mistakes or other errors.

 

[Hopkins2010]

Liontrees,

Under the "evolutionist" phenomena you have described, assuming its an accurate model, I'd say the worst fate of the the programs who dont become more favorable would NOT be that they would go unfilled, but that they would take FMGs instead of US grads.

Ultimately, I agree somewhat with your message. Until this situation becomes absolutely untolerable by many residents (which it currently is not; a lot complain about it privately but when push comes to shove they wont do anything about it) nothing will change.

 

[mpp]

Originally posted by baylor21:
•
Using that line of logic, you could also argue that its a safety IMPERATIVE to mandate all residents to 48 hour shifts and 130 hour work weeks in the name of safety.
•••
I suppose you could argue that but it wouldn't make much sense. The reduction in resident hours will not automatically incur an increase in patient safety, especially if the number of hours is mandated meaning the hospital would require you to leave at that 81st hour.

The ideal situation would be if the residency hours are at a level such that safety of the patient is considered first and the issues of total hours worked and staffing levels are chosen to accomodate that within the funding available. Unfortunately I don't think there is any legislation that would work better than having these decisions made on a patient by patient, hopsital by hospital, and resident by resident basis which is what I hope good residency directors are doing.

Catch-all legislation can never catch all...

 

[MacGyver]

Frankly, I find the argument that "good residency directors" and "good doctors" will do what it takes to keep things at an acceptable level to be extremely naive.

Clearly, by and large they have NOT worked to reduce excessive work hours for residents and most refuse to even recognize there is a problem. Left to their own devices, residency directors generally have NOT shown the initiative to come up with ways to reduce resident workload.

Its very naive to say "well, the hospitals know what they're doing, we should just let them police their own and not worry about it"

Sure, there are a few good programs who recognize that patient health is sacrificed with excessive work hours. Is 80 hours per week excessive? Not necessarily but you DO need to set a limit somewhere. Maybe 85 or 90 hours per week max. But clearly 120 hour work weeks are unacceptable to both patient risk and resident risk. I seriously doubt that residents are learning complex procedures after 36 hours without sleep. Sure, they may be EXPOSED to such learning opportunities, but how many of us REALLY think that they are actually learning/internalizing the knowledge to be used on future patients?

Hospitals and the so-described "benevolent" program directors who are supposedly taking it upon their own good sense and judgment to come up with an acceptable trade off clearly have failed to do so. Its time for an outside authority to step in. They've had their chance.