This came up on a separate thread, which had already derailed significantly from the OP, so I figured I would start a new one.
One thing that occurred to me in the duty hour discussion is that there are just some people who just have higher levels of stamina, who would hypothetically be impaired in order to protect others that are not. Theoretically, these people should self-select, and pick the more intensive, grueling specialties, but the clinical years and rotations are short and its hard to appreciate how personally challenging a year of training will be with only a month or so of exposure.
In the armed forces, you have special forces, who go through multiple phases of training, each with 90%+ attrition. The expectation for everyone else isn't that they perform at the level of a SEAL, Ranger, Delta Force, etc., and they go on to have a different career trajectory with different roles. Not every house staff should be expected to function at the medical equivalent of a Green Beret, but that doesn't mean those who want to should be held back.
So I wonder how feasible it would be to have different programs/subspecialties designate themselves as "special forces," outside of work hour rules. Trainees (and patients) would have the expectation that they would be working longer. There would have to be extra oversight at first to make sure these were quality programs and not malignant slave labor camps. The upside is that these trainees would be hypothetically more desired on the job market.
The biggest issue would be the gunner mentality, pushing some people to go for the most competitive program even if not suitable for them. In the Special Forces, the selection periods go for weeks and months. Ideally, for these training programs there would be some flexibility with a transition year, at which point candidates could opt out into a different track (not ideal, but neither is it for the guys in the Navy who end up on a ship when they wanted to be some super sniper in Afghanistan).
One thing that occurred to me in the duty hour discussion is that there are just some people who just have higher levels of stamina, who would hypothetically be impaired in order to protect others that are not. Theoretically, these people should self-select, and pick the more intensive, grueling specialties, but the clinical years and rotations are short and its hard to appreciate how personally challenging a year of training will be with only a month or so of exposure.
In the armed forces, you have special forces, who go through multiple phases of training, each with 90%+ attrition. The expectation for everyone else isn't that they perform at the level of a SEAL, Ranger, Delta Force, etc., and they go on to have a different career trajectory with different roles. Not every house staff should be expected to function at the medical equivalent of a Green Beret, but that doesn't mean those who want to should be held back.
So I wonder how feasible it would be to have different programs/subspecialties designate themselves as "special forces," outside of work hour rules. Trainees (and patients) would have the expectation that they would be working longer. There would have to be extra oversight at first to make sure these were quality programs and not malignant slave labor camps. The upside is that these trainees would be hypothetically more desired on the job market.
The biggest issue would be the gunner mentality, pushing some people to go for the most competitive program even if not suitable for them. In the Special Forces, the selection periods go for weeks and months. Ideally, for these training programs there would be some flexibility with a transition year, at which point candidates could opt out into a different track (not ideal, but neither is it for the guys in the Navy who end up on a ship when they wanted to be some super sniper in Afghanistan).
