AAMC's view of resident work hours

[LR6SO4]

The AAMC has issued recommendations on resident work hours. Similar to what AMSA wants, with one BIG difference: They would not be mandated by the government. The ACGME would be held responsible for checking to make sure that programs are in compliance, and I would guess that they would disaccredit those that weren't. Here's the link:
<a href="http://www.ama-assn.org/sci-pubs/amnews/pick_01/prse1126.htm" target="_blank">http://www.ama-assn.org/sci-pubs/amnews/pick_01/prse1126.htm</a>

Sounds like a step in the right direction to me, they even address the funding issue that got me really hung up on the AMSA one.

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[Hopkins2010]

I agree with you. Note that the attitude of the program directors is totally focused on the resident. To them, its all about "me, myself and I" I dont hear them talking AT ALL about how patient care suffers when their doctor is sleep deprived and exhausted. They keep coming back to the same theme of "well, you cant learn everything without working 36 hour shift and at least 100 hours per week"

 

[jdub]

baylor21,

from what i have read, when the issue of resident hours was brought up with respect to patient care in the past it failed to make much head-way. so, they are coming more from the resident safety and health side of things.

i imagine that they are coming from this angle because it is probably easier to get a more tangible measurement of the problems that occur with the residents that are sleep deprived, (it is already well documented what sleep deprivation can do to people), where as what type of errors and the abundance of errors that occur while sleep deprived residents are working seems to be a little bit harder to show and is somewhat in a grey area, even though it is quite logical that a tired doc isn't going to preform as well as a well rested doc.

so, i guess what i am saying is that i don't totally agree that the patients point of view and their well being is being compromised by the discussions and ideas being brought up by the aamc.

 

[medgirl02]

I've been told that if they start monitoring resident hours, then to complete RBC requirements, most residents will have to be in residency for more years. I.e. internal medicine will take 5 years instead of 3. Anyone else heard this argument? If that's true, then I'd rather work 100/wk.

 

[jdub]

i haven't heard that argument yet, it sounds possible though, definitely something to look into.

but i was just wondering if you have ever worked 100 hours in a week? how about consecutive weeks? i've only done a 100 hour week a couple of times when i was working at fish hatchery and it was exhausting. it felt like i never left the place. it just seems so lame that one has to completely stop their life for any job or service and working 80+ hours a week would does just that.

sure one could be all stoic, and they might even be thougt of as brave, but it still doesn't negate the fact that doctors in training are people and most people aren't that happy under such constant stress and exhaustion. with comparison to other developed nations one will note that their residents aren't putting in anywhere near the average number of hours as US residents and their health care systems seem to be getting along well enough.

i mean, in the whole scheme of things, what is an extra year or two? why are so many folks in such a hurry? i just can't imagine feeling so different finishing residency at the age of 34 or 35 with respect to getting done at the age of 31 or 32. life could end at any moment, completely putting life on the side seems like such a risky proposition, it's not like we are guarateed 75 years of pristine health, what ever happened to people wanting to seize the day?

one does have to remember that as a resident or intern for that matter, one is a doctor and the more time as a doctor, the more responsibility one will have.

anyhow, just my thoughts on that . . .

 

[Hopkins2010]

I guess i'm confused about how comprehensive a residency should be.

It seems according to the advocates who say you would have to lengthen residencies if you "only" work 80 hours a week that you are not successful in a residency until you have seen every possible procedure that can be performed. Obviously I dont think thats the purpose of a residency. You could be in a ten year residency and still not get exposed to every possible case in that specialty.

Besides, a significant percentage of the time above 80 hours/week is not devoted to seeing new cases or learning new things, but instead is devoted to scutwork. So its not like you are losing 20 hours a week of pure educational time.

Maybe I'm naive, but I just dont buy the automatic assertion that some people state: that to shorten it to 80 hours a week MANDATES a longer training period. Given that you cant see every possible case in a residency, no matter how long that residency training is, why does it automatically follow that working 100-120 hours a week is the "magic number" where a resident MUST be operating at in order to get good training?

Couldnt we get even better training by working 150 hours a week? Couldnt we see even MORE cases and get even MORE exposure to patients with a 150 hour work week? Why not move to that then if the only that matters is what cases the resident is exposed to?

 

[jdub]

i emailed the writer of the article that lr6so4 gave a link to and he responded to my question about extending residency training:

"I have heard this concern, but only from the surgeons. I believe there is a
committee within the American College of Surgeons that is looking into how to
cut down the number of hours to 80 (by going to night float systems) and still
not extend the years from five to six. RRC concerns and board certification
concerns usually are mentioned.
You might call the ACS at 312/202-5000 to find out more.
Hope this helps,
Jay at AMNews
PS. Why are you interested? Are you a student or resident?

Jay Greene
AMNews
Medical education reporter
651/917-1805"

granted, i don't know what the "rbc" is nor do i know who "acs" is, BUT it seems like good info for the folks who are actually in school and residencies right now.

btw, like baylor21, i'd be curious to know if surgery residencies, or any other residency for that matter, couldn't make the hours in the hospital more effecient with relevant material and experience?

 

[Jamier2]

I think this issue could be helped a whole lot if the residency programs would just hire some "aides" to take care of the scutwork. Almost every time someone complains about their residency hours, most of them say that lots of the time is wasted doing the scut crap.