ACGME to decide this month about new intern rules

[2021Doctor]

UN torture report condemns sleep deprivation among US detainees

The US military has retained the power to inflict prolonged sleep deprivation on detainees, despite moves by the Obama administration to eliminate interrogation techniques that amount to torture and ill-treatment, the United Nations warned on Friday.
-----------------------------------------------
Under Appendix M, interrogators are told to avoid exposing detainees to several of the most popular forms of abuse practiced during the Bush years, such as deafening noises, freezing cells or incessant light. However, the rulebook goes on to give permission for detainees to be kept awake for up to 20 hours a day.
It says: “Use of separation must not preclude the detainee getting four hours of continuous sleep every 24 hours.”
UN torture report condemns sleep deprivation among US detainees

The State Department regularly lists sleep deprivation as a form of torture in its annual report on human rights abuses.
Memos show CIA pushed limits on sleep deprivation

This month, the Accreditation Council for Graduate Medical Education will decide whether interns should be allowed the same 28-hour shifts senior residents work instead of the current, 16-hour shift maximum.
Kelsey Pendleton, MD, family medicine resident at St. Margaret Hospital in Pittsburgh, is one of many residents, physicians and watchdog groups not in favor of lifting the restrictions.

http://medicaleconomics.modernmedic...2F-A6DD-8C69DE39FB5A&rememberme=1&ts=15022017

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[ThoracicGuy]

 

[Shikima]

It's a shame that forces have undone the work from the sleep community advocacy.

 

[BoardingDoc]

 

[Raryn]

Q: Is it torture?

A: No.

/endthread.

 

[BoardingDoc]

Ok. So apparently you disagree with the United Nations and the US State Department regarding sleep deprivation as torture.

There is a fundamental difference between being a physician who is working without adequate sleep and being a prisoner who is forcibly being kept awake by his/her captors. There are reasons why similar actions have very different contexts depending on the circumstance.

Shooting someone in the head unprovoked is murder. Unless you're an army sniper during war-time. Your argument is akin to saying "do you think all soldiers who have killed someone should be jailed?" Of course not. The scenarios are fundamentally different, and as such, the rules of one scenario should not directly translate into another.

If you want to open a discussion about how residents are overworked, that's fine, but I think we can do it without referencing the Geneva Conventions.

 

[LucidSplash]

Please explain how forcing residents to work without sleep is not comparable to forcing prisoners to go without sleep.
Both involve the use of force and coercion by one party upon another party.

Please explain how missing out on a few hours of sleep once or twice a week is the same as prolonged sleep deprivation experienced by POWs. Really. Do you even hear yourself? You are actually comparing yourself to someone being tortured??

Also I have done both night float and 24-hour and night float is 100x worse. Night float throws circadian rhythms out the window for a month at a time and made me bat****.

 

[Raryn]

Ok. So apparently you disagree with the United Nations and the US State Department regarding sleep deprivation as torture.
Are you a faculty member of a residency program?

I am a graduate of a residency program. One who did both some 28 hour shifts (though not all that many) as well as a fair bit of night float.

I prefer the 28 hour shifts.

 

[LucidSplash]

Did you read:
"Under Appendix M, interrogators are told to avoid exposing detainees to several of the most popular forms of abuse practiced during the Bush years, such as deafening noises, freezing cells or incessant light. However, the rulebook goes on to give permission for detainees to be kept awake for up to 20 hours a day.
It says: “Use of separation must not preclude the detainee getting four hours of continuous sleep every 24 hours.”
"The State Department regularly lists sleep deprivation as a form of torture in its annual report on human rights abuses."

Residents do not get 4 hours of continuous sleep every 24 hours. So in that area they are being treated worse than these POWs or terrorists at places like Guantanamo Bay..

What? Where are you in your training, premed be Med student vs resident?? You don't appear to actually have any experience with taking call. I'm a chief resident in general surgery and I definitely get a lot MORE than 4 hours of continuous sleep almost every night and have for the majority of my residency. On call you might get less but at most that is 1 in 3 and the rules say you go home after 28 hours and sleep as long as you want. That is a far cry from getting only 4 hours/night for weeks on end.

 

[2021Doctor]

What? Where are you in your training, premed be Med student vs resident?? You don't appear to actually have any experience with taking call. I'm a chief resident in general surgery and I definitely get a lot MORE than 4 hours of continuous sleep almost every night and have for the majority of my residency. On call you might get less but at most that is 1 in 3 and the rules say you go home after 28 hours and sleep as long as you want. That is a far cry from getting only 4 hours/night for weeks on end.

Nice try. The regulations on torture say nothing about "weeks on end".
"Use of separation must not preclude the detainee getting four hours of continuous sleep every 24 hours."

I am an attending. I had many 24+ hour stretches of call with zero to near zero (<30 minutes) sleep.
After reading about the UN, State Department, and Geneva Convention positions on torture, I can now categorize myself a survivor of habitual torture for several years during residency.

 

[LucidSplash]

Nice try. The regulations on torture say nothing about "weeks on end".
"Use of separation must not preclude the detainee getting four hours of continuous sleep every 24 hours."

I am an attending. I had many 24+ hour stretches of call with zero to near zero (<30 minutes) sleep.
After reading about the UN, State Department, and Geneva Convention positions on torture, I can now categorize myself a survivor of habitual torture for several years during residency.

Based on your post history I in no way, shape, or form believe that you are an attending physician. To hear you speak it's as if you never pulled an all nighter in school or stayed up past your bedtime. Frankly you're being downright histrionic. If you read those regulations the clear intent is talking about someone who's being deprived of sleep for an extended period of time not just for a single 24 hour period.

Now, internal medicine rounds, those are torture.

 

[LucidSplash]

"Use of separation must not preclude the detainee getting four hours of continuous sleep every 24 hours."

You selectively left out the paragraph where it says for 30 days at a time.

 

[BoardingDoc]

Nice try. The regulations on torture say nothing about "weeks on end".
"Use of separation must not preclude the detainee getting four hours of continuous sleep every 24 hours."

I am an attending. I had many 24+ hour stretches of call with zero to near zero (<30 minutes) sleep.
After reading about the UN, State Department, and Geneva Convention positions on torture, I can now categorize myself a survivor of habitual torture for several years during residency.

Did you have 30+ straight days of call with no sleep? The regulation specifically states that it is permissible for up to 30 days at a time before it needs to be reviewed. And the fact that you are calling yourself "a survivor of habitual torture for several years during residency" is something that I suspect actual torture survivors would find offensive.

 

[LucidSplash]

Another factor to consider is safety. I believe that doctors are still considered human beings.

OBJECTIVES—To compare the relative effects on performance of sleep deprivation and alcohol.
METHODS—Performance effects were studied in the same subjects over a period of 28 hours of sleep deprivation and after measured doses of alcohol up to about 0.1% blood alcohol concentration (BAC). There were 39 subjects, 30 employees from the transport industry and nine from the army.
RESULTS—After 17-19 hours without sleep, corresponding to 2230 and 0100, performance on some tests was equivalent or worse than that at a BAC of 0.05%. Response speeds were up to 50% slower for some tests and accuracy measures were significantly poorer than at this level of alcohol. After longer periods without sleep, performance reached levels equivalent to the maximum alcohol dose given to subjects (BAC of 0.1%).
CONCLUSIONS—These findings reinforce the evidence that the fatigue of sleep deprivation is an important factor likely to compromise performance of speed and accuracy of the kind needed for safety on the road and in other industrial settings.

"The results also imply that many countries which set allowable BACs at the point that compromises safe performance should consider developing similar standards for fatigue to ensure that people who have had 18 hours or longer without sleep are kept from at risk behaviours such as driving, piloting aircraft, or operating machinery."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1739867/pdf/v057p00649.pdf

"Don't modulate the key then not debate with me." ~Lin-Manuel Miranda

39 Australian soldiers from a paper written in 2000. Not exactly well-powered or in any way blinded.

And the FIRST trial showed no difference in patient safety before the 2011 ACGME rules and after.

 

[Raryn]

Based on your post history I in no way, shape, or form believe that you are an attending physician. To hear you speak it's as if you never pulled an all nighter in school or stayed up past your bedtime. Frankly you're being downright histrionic. If you read those regulations the clear intent is talking about someone who's being deprived of sleep for an extended period of time not just for a single 24 hour period.

Now, internal medicine rounds, those are torture.

The OP has been posting on SDN for four years, looks like mostly "the end of the world" type threads trying to get a rise out of people. Some of the highlights include posting in the radiology/anesthesia/pathology forums about decreasing reimbursements, uncountable numbers of posts in pre-osteo about how so many new schools opening is going to saturate the market, multiple threads about news articles of physician misconduct leading to loss of license (or med student misconduct leading to being expelled), and now this thread.

I think I agree with post #4 above.

 

[LucidSplash]

Classic tactic. Kill the messenger when you don't like the message.
The facts are unchanged.
Does not make sense to me that denying someone a basic human right every third or fourth night is not considered torture.

Thursday, December 10, marks the 67th anniversary of the adoption of the Universal Declaration of Human Rights by the United Nations General Assembly, which recognized that “all human beings are born free and equal in dignity and rights.”
One of those inalienable human rights is the right to rest. Article 24 of the Declaration states that: “Everyone has the right to rest and leisure, including reasonable limitation of working hours and periodic holidays with pay.”
http://vanwinkles.com/according-to-the-united-nations-housing-and-sleep-are-basic-human-rights

Nothing in that clashes with the ACGME regulations pre-2011. Your outrage would be better placed on companies that manufacture their products in foreign sweatshops.

:troll:

 

[2021Doctor]

Dr. Christopher Landrigan, a Harvard Medical School professor and leading voice for work hour reform, thinks the 2003 regulations didn’t go far enough, which is why their impact was not evident. After all, they still allowed shifts up to 30 hours, which is far beyond the workday of almost any other profession.

“Doctors think they’re a special class and not subject to normal limitations of physiology,” he told the New York Times magazine.

Sleep deprivation has a well-documented negative impact on cognition and memory, fine motor skills, mood and reaction time. And that’s just acute sleep deprivation, meaning the occasional all-nighter. Long-term sleep deprivation, like the kind medical residents may experience over the course of three years, can seriously damage memory, increase the risk of heart disease and even decrease a person’s lifespan.

http://www.huffingtonpost.com/entry...dent-labor-crisis_us_573b25fae4b060aa781b411f

 

[VA Hopeful Dr]

Nothing in that clashes with the ACGME regulations pre-2011. Your outrage would be better placed on companies that manufacture their products in foreign sweatshops.

:troll:

I didn't know that a good night's sleep was a human right. That makes my twin 15 month olds absolute monsters...

 

[gutonc]

I didn't know that a good night's sleep was a human right. That makes my twin 15 month olds absolute monsters...

Exactly...when my kid was a baby I got way more sleep on 30h calls than I did most other nights at home.

 

[LucidSplash]

Dr. Christopher Landrigan, a Harvard Medical School professor and leading voice for work hour reform, thinks the 2003 regulations didn’t go far enough, which is why their impact was not evident. After all, they still allowed shifts up to 30 hours, which is far beyond the workday of almost any other profession.

“Doctors think they’re a special class and not subject to normal limitations of physiology,” he told the New York Times magazine.

Sleep deprivation has a well-documented negative impact on cognition and memory, fine motor skills, mood and reaction time. And that’s just acute sleep deprivation, meaning the occasional all-nighter. Long-term sleep deprivation, like the kind medical residents may experience over the course of three years, can seriously damage memory, increase the risk of heart disease and even decrease a person’s lifespan.

http://www.huffingtonpost.com/entry...dent-labor-crisis_us_573b25fae4b060aa781b411f

Again, the FIRST trial showed otherwise and that guy is in the minority. You can selectively cut and paste the words of others all day long but it doesn't change the consensus data or the anecdotal experience of people who have actually been through it. Most residents who have been subject to both sets of rules vastly prefer the pre-2011 hours for sleep hygiene. Regular night float is pretty awful in that regard, far worse than any 30-hour shift.

 

[LucidSplash]

But regardless of your nonsense, the rest of us can just sit back and enjoy the satisfaction that the ACGME will almost certainly roll back the 16-hour rule for interns. You can whine and stamp your feet and complain to the UN if you like, but I suspect they have bigger fish to fry given the current state of world affairs and the actual (not perceived) dearth of basic human rights in many places.

There's a lot going wrong in the world right now but it's nice that the wrong of ACGME 2011 will finally be put right.

 

[LucidSplash]

RW: Why do you think nursing has addressed this more than medicine?

CL: A fundamental tenet of the American residency education system for the better part of the century has been that, in order to be well trained as a physician, you need to be at the bedside continuously (or at least continuously available), watching the progress of the illness as patients potentially go into the intensive care unit and then eventually get better. I think what has shifted over time is that the amount of activity that interns are engaged in has exploded, to the point that they have gone from sleeping 5 to 6 hours per night to 3 or 4 hours per night to, at least in many academic centers, frequently getting no sleep at all. When that happens, their ability to function is deeply impaired and, as a consequence, I think we find the kinds of results that we saw in our study.

RW: Any parting words?

CL: I wanted to point out just how many people this affects. There are currently more than 100,000 residents in the United States, and most of them work these schedules on a regular basis. While the medical community appreciates the frequency of these long work hours, the general public is mainly unaware of the extended hours that doctors work. A 2002 survey by the National Sleep Foundation found that members of the public generally feel that doctors ought to work shifts of less than 10 hours. They would be shocked that surgeries are being performed and intensive care is routinely delivered by doctors who have been working for longer than 24 hours.

https://psnet.ahrq.gov/perspectives/perspective/2

Yeah but basing things on how someone "feels" about something they don't have any working knowledge of is pretty useless. Like saying patient outcomes are less important than HCAHP scores, which have routinely shown an inverse correlation.

Ok. Enjoy yourself fellas. I have some Chinese food to devour and television to watch. Good night!

 

[WholeLottaGame7]

Dr. Christopher Landrigan, a Harvard Medical School professor and leading voice for work hour reform, thinks the 2003 regulations didn’t go far enough, which is why their impact was not evident. After all, they still allowed shifts up to 30 hours, which is far beyond the workday of almost any other profession.

“Doctors think they’re a special class and not subject to normal limitations of physiology,” he told the New York Times magazine.

Sleep deprivation has a well-documented negative impact on cognition and memory, fine motor skills, mood and reaction time. And that’s just acute sleep deprivation, meaning the occasional all-nighter. Long-term sleep deprivation, like the kind medical residents may experience over the course of three years, can seriously damage memory, increase the risk of heart disease and even decrease a person’s lifespan.

http://www.huffingtonpost.com/entry...dent-labor-crisis_us_573b25fae4b060aa781b411f

The only thing I disagree with you on is that you're calling it torture. Torture is involuntary. Last I checked, this was the US of A, not Guantanamo. No one is forcing you to become a doctor. You will lose your career, but you can walk out at any time and no one can stop you. If it were truly torture, there would be men with guns and barbed wire and high walls keeping you in the hospital against your will. The fact that you either do not or choose not to understand this are both problematic.

 

[Raryn]

Ok. But once you go to medical school you are basically FORCED to do a residency to get a job and not be bankrupted by educational debt.
PAs and NPs are not forced to do any residency.

There's plenty of IM programs that completely did away with 28 hour shifts and are not planning on bringing them back. There's also a number in specialties that have never done them. I've never heard of a dermatologist working an 11 hour shift, much less 28. Psychiatrists don't do the long shifts either, nor do pathologists, etc. etc. etc. Now, they may take home call and be woken up all hours of the night, but that's part of being a frackin doctor.

If you consider it torture, do not voluntarily go to a program that requires these shifts. If that means you can't be a neurosurgeon like you've always dreamed? Tough.

Now, you can argue about the transition, as in what to do if your program changes their scheduling after you start... but that's a whole separate question.

 

[WholeLottaGame7]

Ok. But once you go to medical school you are basically FORCED to do a residency to get a job and not be bankrupted by educational debt.
PAs and NPs are not forced to do any residency.

OK good, so at least now you are recognizing the difference between physical force, which is what torture is, to more metaphorical forces, like economic and professional consequences. Can we drop the torture analogy now?

The fact that there are consequences to your decisions is called life. Welcome!

On a less sarcastic note, it is true that is hard to imagine what physician life is like from the outside. We all make a leap of faith to some degree on entering the profession. But there are myriad points along the way where you have the ability to do your due diligence and ask questions and re-evaluate. How many years will this be? How much will this cost? How much studying do I have to do? How many hours do I have to work? Some things are subjective and hard to find out, others aren't.

 

[rokshana]

Nice try. The regulations on torture say nothing about "weeks on end".
"Use of separation must not preclude the detainee getting four hours of continuous sleep every 24 hours."

I am an attending. I had many 24+ hour stretches of call with zero to near zero (<30 minutes) sleep.
After reading about the UN, State Department, and Geneva Convention positions on torture, I can now categorize myself a survivor of habitual torture for several years during residency.

Seriously?? you are being ever so disrespectful to those who truly have gone through torture...

 

[AdmiralChz]

Comparing residency - where BTW you get paid - to a POW situation where you a captor of individuals who literally want to kill you and hate your country is more than just a bad comparison and short sighted. It's reckless, inappropriate and completely offensive to those who have put their lives on the line for this country. Shameful post. No on is forcing you into medicine or doing residency, if you don't agree with it than don't do it.

Literally almost everyone would admit that doctors in training today have a much, much improved schedule than those 10 or 20 years ago. Educate yourself on why it's called "residency" and why those in it are deemed "house staff." Or just go away.

 

[Perrotfish]

Literally almost everyone would admit that doctors in training today have a much, much improved schedule than those 10 or 20 years ago. Educate yourself on why it's called "residency" and why those in it are deemed "house staff."

Any academic attending would say that residents today have a much better schedule than 10 or 20 years ago. Anyone else, for example someone who looks at the numbers, would say that those attendings are bald faced liars. The number of admissions performed by medicine residents has climbed year after year for the last two decades. The average complexity of an admitted patients has also risen. These numbers, unlike work hour numbers, are submitted to insurance agencies for reimbursement and are routinely audited to prevent fraud, and therefore can't be easily faked. The only way this is possible is if residents are working more hours, which they are. The reason that this is consistent with the work hour rules is because:

1) Everyone lies about work hours, and residents actually work 100 hours/week on most inpatient rotations not even counting academic responsibilities and studying.

and

2) When the work hour rules were put into place residents were only working about 80 hours/week.

Your attendings weren't lying that the work hour rules got rid of a few nightmare rotations, where they took Q2 call or 24/7 ICU call or whatever, but those were rare exceptions that your attendings only remember because of how insane they were. On average your attendings worked much less 20 years ago than you do now.

BTW residents are called 'residents' because they used to be paid mainly with room and board in the hospital, not because they were expected to actually work in the hospital 24/7. Residents being underpaid is nothing new, but the around the clock schedule is something we invented just in the last few generations. Actually when Osler invented residency medicine had a reputation as a profession that was much lighter on hours than the more demanding professions of law and finance. One of my favorite parts of 'Dr Mutter's Marvels' was when Mutter made the decision to switch into medicine because he was too sickly to work the early mornings and late nights of a 19th century college student, so he switched to the much lighter schedule of a 19th century medical student.

 

[2021Doctor]

Any academic attending would say that residents today have a much better schedule than 10 or 20 years ago. Anyone else, for example someone who looks at the numbers, would say that those attendings are bald faced liars. The number of admissions performed by medicine residents has climbed year after year for the last two decades. The average complexity of an admitted patients has also risen. These numbers, unlike work hour numbers, are submitted to insurance agencies for reimbursement and are routinely audited to prevent fraud, and therefore can't be easily faked. The only way this is possible is if residents are working more hours, which they are. The reason that this is consistent with the work hour rules is because:

1) Everyone lies about work hours, and residents actually work 100 hours/week on most inpatient rotations not even counting academic responsibilities and studying.

and

2) When the work hour rules were put into place residents were only working about 80 hours/week.

Your attendings weren't lying that the work hour rules got rid of a few nightmare rotations, where they took Q2 call or 24/7 ICU call or whatever, but those were rare exceptions that your attendings only remember because of how insane they were. On average your attendings worked much less 20 years ago than you do now.

BTW residents are called 'residents' because they used to be paid mainly with room and board in the hospital, not because they were expected to actually work in the hospital 24/7. Residents being underpaid is nothing new, but the around the clock schedule is something we invented just in the last few generations. Actually when Osler invented residency medicine had a reputation as a profession that was much lighter on hours than the more demanding professions of law and finance. One of my favorite parts of 'Dr Mutter's Marvels' was when Mutter made the decision to switch into medicine because he was too sickly to work the early mornings and late nights of a 19th century college student, so he switched to the much lighter schedule of a 19th century medical student.

Absolutely correct.
Patients now in the hospital are also much sicker than in the past.
There are much fewer soft admissions.
There are also much shorter length of stays so that the workload every day includes more admissions and more discharges due to higher churn rate of patients.

 

[2021Doctor]

Comparing residency - where BTW you get paid - to a POW situation where you a captor of individuals who literally want to kill you and hate your country is more than just a bad comparison and short sighted. It's reckless, inappropriate and completely offensive to those who have put their lives on the line for this country. Shameful post. No on is forcing you into medicine or doing residency, if you don't agree with it than don't do it.

Literally almost everyone would admit that doctors in training today have a much, much improved schedule than those 10 or 20 years ago. Educate yourself on why it's called "residency" and why those in it are deemed "house staff." Or just go away.

Sorry but total nonsense.


A declining overall number of acute care beds due to cost containment measures, the shifting of many formerly hospitalized patients to outpatient care (e.g., increased use of ambulatory surgery), and reduced length of stay have meant that the inpatient population that residents care for today is sicker and more equivalent to the patients in intensive care units (ICUs) 20 to 30 years ago (Carayon and Gurses, 2005; Ludmerer, 1999; Oransky, 2003).
............
The average length of stay over the past 25 years has decreased dramatically: 7.3 days in 1980, 6.4 in 1990, 4.9 in 2000, and 4.8 in 2004 (Kozak et al., 2006). In fact, many hospital stays are shorter than 4.8 days.
.........
Admissions and discharges are among the most time-consuming and complex tasks that residents must complete (Dellit et al., 2001), and for many specialties these activities are limiting factors in the caseload that can be managed thoroughly within allotted duty hours.
https://www.ncbi.nlm.nih.gov/books/NBK214944/


Here is a recent discussion of sleep deprivation as torture per the Army Field Manual:
http://mediamatters.org/blog/2017/0...aiming-sleep-deprivation-isn-t-torture/215122

 

[2021Doctor]

Look at the vast changes in internal medicine at Barnes after implementaton of the prospective payment system:
Before prospective payment, the service was covered by teams consisting of a resident, intern, and medical students.
A typical call resulted in three new admissions (a fourth admission made the day unusually heavy) and the average length of stay was around 10 days.
Within a decade under the new system, the average length of stay had fallen to four days and each team was working up 14 admissions per call day.
A second intern had been added to the teams, so each intern regularly worked up seven patients.
The supervising resident looked over the new patients to guard against flagrant error or oversight.
However, the resident no longer worked up patients himself as before.
https://muse.jhu.edu/article/586380

 

[hamstergang]

1) Everyone lies about work hours, and residents actually work 100 hours/week on most inpatient rotations not even counting academic responsibilities and studying.

I don't know if your experience is as generalizable as you think wrt the above quote, but very interesting post otherwise.

 

[VA Hopeful Dr]

Paging @Winged Scapula to do her usual proving wrong of the tired old "before the work hour rules residents admitted fewer patients and they had longer length of stays" nonsense.

 

[VA Hopeful Dr]

I don't know if your experience is as generalizable as you think wrt the above quote, but very interesting post otherwise.

Yeah, I broke work hours exactly once - 3 back to back continuity OB patients went into labor. The remaining 2.99 years were within the rules.

Plus everyone seems to forget that a) we're getting paid and b) it's entirely voluntary. Does residency suck? Yeah, it often does. Are there fields with worse hours than residency? Absolutely. My OB father in-law works Friday AM to Monday AM once a month. Doesn't leave the hospital at all. Sometimes gets good sleep, sometimes doesn't. Same schedule with our pulmonologists in residency. That's 72 hours straight. But sure, tell me again how bad 28 hours is.

 

[Mad Jack]

Any academic attending would say that residents today have a much better schedule than 10 or 20 years ago. Anyone else, for example someone who looks at the numbers, would say that those attendings are bald faced liars. The number of admissions performed by medicine residents has climbed year after year for the last two decades. The average complexity of an admitted patients has also risen. These numbers, unlike work hour numbers, are submitted to insurance agencies for reimbursement and are routinely audited to prevent fraud, and therefore can't be easily faked. The only way this is possible is if residents are working more hours, which they are. The reason that this is consistent with the work hour rules is because:

1) Everyone lies about work hours, and residents actually work 100 hours/week on most inpatient rotations not even counting academic responsibilities and studying.

and

2) When the work hour rules were put into place residents were only working about 80 hours/week.

Your attendings weren't lying that the work hour rules got rid of a few nightmare rotations, where they took Q2 call or 24/7 ICU call or whatever, but those were rare exceptions that your attendings only remember because of how insane they were. On average your attendings worked much less 20 years ago than you do now.

BTW residents are called 'residents' because they used to be paid mainly with room and board in the hospital, not because they were expected to actually work in the hospital 24/7. Residents being underpaid is nothing new, but the around the clock schedule is something we invented just in the last few generations. Actually when Osler invented residency medicine had a reputation as a profession that was much lighter on hours than the more demanding professions of law and finance. One of my favorite parts of 'Dr Mutter's Marvels' was when Mutter made the decision to switch into medicine because he was too sickly to work the early mornings and late nights of a 19th century college student, so he switched to the much lighter schedule of a 19th century medical student.

Medicine also used to be a fairly poorly paid profession with little prestige and few tools to actually help patients (and thus were viewed as harbingers of death and the last person you ever wanted to call more than a force of good). Much has changed, and it's really a fascinating history that many people within the field are unaware of.

 

[Raryn]

Any academic attending would say that residents today have a much better schedule than 10 or 20 years ago. Anyone else, for example someone who looks at the numbers, would say that those attendings are bald faced liars. The number of admissions performed by medicine residents has climbed year after year for the last two decades. The average complexity of an admitted patients has also risen. These numbers, unlike work hour numbers, are submitted to insurance agencies for reimbursement and are routinely audited to prevent fraud, and therefore can't be easily faked. The only way this is possible is if residents are working more hours, which they are. The reason that this is consistent with the work hour rules is because:

1) Everyone lies about work hours, and residents actually work 100 hours/week on most inpatient rotations not even counting academic responsibilities and studying.

and

2) When the work hour rules were put into place residents were only working about 80 hours/week.

Your attendings weren't lying that the work hour rules got rid of a few nightmare rotations, where they took Q2 call or 24/7 ICU call or whatever, but those were rare exceptions that your attendings only remember because of how insane they were. On average your attendings worked much less 20 years ago than you do now.

BTW residents are called 'residents' because they used to be paid mainly with room and board in the hospital, not because they were expected to actually work in the hospital 24/7. Residents being underpaid is nothing new, but the around the clock schedule is something we invented just in the last few generations. Actually when Osler invented residency medicine had a reputation as a profession that was much lighter on hours than the more demanding professions of law and finance. One of my favorite parts of 'Dr Mutter's Marvels' was when Mutter made the decision to switch into medicine because he was too sickly to work the early mornings and late nights of a 19th century college student, so he switched to the much lighter schedule of a 19th century medical student.

[citation needed]

I can absolutely say your work hour assertions aren't universally generalizable. I can't say I *never* came close to breaking duty hours. There were maybe 2 weeks in residency I approached 100 hours on an ICU block, and I went to a clinically heavy residency that had all hour/patient caps set at the maximum allowed by the ACGME. Those 2 weeks we went above the # patient cap because our closed ICU was overwhelmed with an unexpected number of sick people we had nowhere else to send, but they were also balanced by some easier weeks on either side. Maybe I averaged a bit more than 80 hours/week that block, I will admit I didn't accurately log hours at that point (and our program director went to the wall to change the ICU team structure later on to decrease the odds of a situation like that falling on the backs of the housestaff again).

The remaining 35 months of residency, I worked <80hours/week, as averaged over a 4 week rotation. I might have broken 16 hours/shift as an intern a few times at the beginning of the year, or not had my full 8-10 hours out of the hospital, but these things do rarely happen with specific clinical context, and the overarching 80hours/week at least I didn't break.

Look, length of stay has come down and turnover is up, yes. But anecdotally from the older physicians I've talked to at least, the overall census seen by a team has also come down. You have more new patients and fewer old ones than physicians a generation before. Maybe they're lying to me or misremembering, but it makes some intuitive sense.

To say that the # of admissions has climbed up "year after year" without evidence is something that would highly surprise me if true. In internal medicine at least, the maximum team cap of 20 patients/team with a maximum of 10 admissions for an individual senior resident in 24 hours (and 16 admissions for a team in 48 hours) has been in place for a while... and many, many IM programs have patient # caps set significantly lower than the maximum. Of course, surgical services it depends more on operative volumes and I know absolutely nothing of those, so I suppose your assertion could be true for certain programs, but not across the board of specialties.

 

[Psai]

The worst part of the intern 16 hour rule is that you don't hang with your resident the whole time. That's invaluable. Also I've done >24 hours in a row as a medical student and I greatly prefer that to coming in early and leaving late everyday.

The 6 days a week stupidity forces people who make the schedule into things that really mess with your sleep system like 6 nights in a row then 1 random night some other week or 3 nights and 4 nights later. I'd rather do a week of nights and get it over with instead of constantly change my sleep schedule and be tired all the time.

Rules may be well intentioned but they're ****ing annoying.

 

[SouthernSurgeon]

Any academic attending would say that residents today have a much better schedule than 10 or 20 years ago. Anyone else, for example someone who looks at the numbers, would say that those attendings are bald faced liars. The number of admissions performed by medicine residents has climbed year after year for the last two decades. The average complexity of an admitted patients has also risen. These numbers, unlike work hour numbers, are submitted to insurance agencies for reimbursement and are routinely audited to prevent fraud, and therefore can't be easily faked. The only way this is possible is if residents are working more hours, which they are. The reason that this is consistent with the work hour rules is because:

1) Everyone lies about work hours, and residents actually work 100 hours/week on most inpatient rotations not even counting academic responsibilities and studying.

and

2) When the work hour rules were put into place residents were only working about 80 hours/week.

Your attendings weren't lying that the work hour rules got rid of a few nightmare rotations, where they took Q2 call or 24/7 ICU call or whatever, but those were rare exceptions that your attendings only remember because of how insane they were. On average your attendings worked much less 20 years ago than you do now.

BTW residents are called 'residents' because they used to be paid mainly with room and board in the hospital, not because they were expected to actually work in the hospital 24/7. Residents being underpaid is nothing new, but the around the clock schedule is something we invented just in the last few generations. Actually when Osler invented residency medicine had a reputation as a profession that was much lighter on hours than the more demanding professions of law and finance. One of my favorite parts of 'Dr Mutter's Marvels' was when Mutter made the decision to switch into medicine because he was too sickly to work the early mornings and late nights of a 19th century college student, so he switched to the much lighter schedule of a 19th century medical student.

20 years ago was...1997...

While there have been marginal increases in volume since then, to suggest that residency was somehow radically different in the early aughts than it is now is hard to swallow.

I've been in the medical world for 11 of those twenty years and if anything residents have it better now than they did then. The whole field of hospitalist medicine and non-teaching services has arisen over that timespan. Hospitals hiring more APPs. Etc.

I would also echo others that your experience with the work hours is far from generalizable. I'm a general surgery resident and have broken the eighty hours 3 times this year. Twice on trauma and once at the VA. Last week I worked less than sixty. Average for the year is well under 80

 

[ProfMD]

1) Work hours were instituted (28 hours in 2003, 16 hours for interns in 2011) primarily for concerns of patient safety. Numerous studies have shown no benefit in this regard.

2) There is growing concern, particularly in surgical specialities, that due to the hour restrictions residents are not getting the experience they need to be ready for independent practice at graduation.

3) ACGME is not proposing going back to the old way (36 hours on, 12 hours off for example). Merely rolling back to the 2003 rules (which never changed for anyone other than interns).

4) Patient acuity has not changed that much since ACGME started making these rules.

5) I also manged to work within the hour restrictions.

6) https://forums.studentdoctor.net/th...ts-work-longer-shifts-acgme-proposes.1228419/

7) Comparing our experiences as residents to torturing prisoners is like Donald Trump comparing venereal disease to the Vietnam War.

 

[TooMuchResearch]

Nice try. The regulations on torture say nothing about "weeks on end".
"Use of separation must not preclude the detainee getting four hours of continuous sleep every 24 hours."

I am an attending. I had many 24+ hour stretches of call with zero to near zero (<30 minutes) sleep.
After reading about the UN, State Department, and Geneva Convention positions on torture, I can now categorize myself a survivor of habitual torture for several years during residency.

You tell people you were tortured in residency?

What do they say when you explain your thought process?

It's not torture; it just sucks.

 

[rokshana]

Absolutely correct.
Patients now in the hospital are also much sicker than in the past.
There are much fewer soft admissions.
There are also much shorter length of stays so that the workload every day includes more admissions and more discharges due to higher churn rate of patients.

my father, who did his surgical residency in the late 60s and early 70s would disagree with perrotfish about who worked harder and was expected to give ALL their time (free time and work/life balance were not really in their vocabulary) - i have heard the stories to prove it! and current day surgical residents will agree that even as crazy as their schedules are now, they don't compare to those residents from my fathers's time... and i, as a hospitalist, mot definitely disagree about the lack of "soft" admissions...

 

[J ROD]

The OP is probably sitting back laughing at how he is getting folks to reply over and over again.......don't feed the thread.

Simple.....residency is not torture. It sucks and I am an intern that has worked the 28hr shifts in the pilot program and done night float. I got 2 hrs of continuous sleep in that 28 hr period. Neither was torture.

I think the pay is the bigger wrong. I believe it should at least be around 100K. Based on what other professions make and what we do. They don't have a 4 yr period of servitude like medicine does. I literally have been told by an attending this year, you will do as you are told because we own you. And sad part is, they are right. I feel I have no recourse. Talk about your slave master mentality.....

 

[VA Hopeful Dr]

The OP is probably sitting back laughing at how he is getting folks to reply over and over again.......don't feed the thread.

Simple.....residency is not torture. It sucks and I am an intern that has worked the 28hr shifts in the pilot program and done night float. I got 2 hrs of continuous sleep in that 28 hr period. Neither was torture.

I think the pay is the bigger wrong. I believe it should at least be around 100K. Based on what other professions make and what we do. They don't have a 4 yr period of servitude like medicine does. I literally have been told by an attending this year, you will do as you are told because we own you. And sad part is, they are right. I feel I have no recourse. Talk about your slave master mentality.....

Oh good, another topic that's been done to death...