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AMSA and resident work hours

Discussion in 'Medical Students - MD' started by LR6SO4, Nov 11, 2001.

  1. LR6SO4

    LR6SO4 Senior Member
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    AMSA has released a statement in support of limiting resident work hours and this has been made into a bill going before congress. All of this is happening in my home state (MI) and I just wanted to see what the opinions of others were. It looks real similar to the NY laws, 80 hours, no more than a 24 hr shift, 12 in ER, ect. I think NY speaks for itself in that it didn't work. I am explicitly opposed to this and hope others are as well, tell me if you have any good ideas as to how to stop it! What is the AMA stance on this (AMSA tends to be so liberal it's sick--that's why I'm not a member!). Here's the link: <a href="http://www.amsa.org/hp/reswork.cfm" target="_blank">http://www.amsa.org/hp/reswork.cfm</a>
    thanks for any input!
     
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  3. simpleton

    simpleton Senior Member
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    I agree with LR6SO4, no matter what laws are passed it still won't stop the rigors of being a resident. Pre-meds should know this kind of thing before pursuing a career in medicine. The way it is now is the ways its always going to be. The only thing I would be in favor of is if residents were paid more but I could care less about the hours thing. AMSA is too liberal for me too. There is a lot to say about an organization that is trying to fundamentally change the way doctors learn.
     
  4. Salman20001

    Salman20001 Member
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    I am sorry but I have to disagree with both of you...In my personal opinion, it does make sense that residency hours must be cut down a bit...this benefits both the resident and the patient (who can be looked after by an alert resident)...sure you guys could probably handle the load etc, but on average residents do feel overworked and extremely exahausted (depending on their field of speciality of course..), and that is a BAD state of mind to be in when treating humans.... what about ny? every state has its fair share of problem but I don't think you can allude it to just one factor...also, initially, sacrifices must be made for a change that will benefit in the long run..As for cutting down into your learning, I am sorry but if you are really keen on learning more, watch some videos and read books after the 80 hours if its your choice, just don't force it on normal people who might need a break....Medicine requires sacrifices but that doesn't mean it cannot change to ease that burden a bit...

    I can't believe in such an open minded society, people still stay stuff like


     
  5. e2k

    e2k Member
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    I agree that residents work too many hours. I don't think anyone benefits except the hospital (free labor) and the faculty (less hours for them).

    The proponents of the current system say that you need to work hours on end to learn continuity of care. I think that's a load of crap. I'm training here in Israel, where the Medicine residents work about 50 hours a week, and they learn very well.

    I believe a nationwide bill is a good idea. However, without some sort of organization with the power to enforce the decision, I feel it will fall in the same place as NYC.

    Resident unions are a good idea in theory, but the major bargaining power of a union is the ability to strike. Most residents simply aren't willing to do that, either out of duty or fear.

    (We have doctor's strikes here in Israel All elective procedures and nonemergent admissions are cancelled. Actually, overall patient mortality DECREASES during doctor strikes, so it's not so bad for patients.)

    I think a major policy shift is going to be required in order to reduce resident work hours. Either more PAs/NPs will have to be hired to take up the slack, or more residency positions will have to be created. To really turn the tide, the U.S. will need more med schools, or hire even more foreign doctors.

    Established doctors don't like that idea, because they feel that medicine is competative enough. Salaries will drop even further, and some doctors will actually be out of work. In other words, the AMA and the establishment like to keep a shortage of docs to make themselves more valuble. This means that residents are going to have to work their asses off in order to get the fat rewards of the future.

    ERIC
     
  6. guardian

    guardian Senior Member
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  7. Cobragirl

    Cobragirl Hoohaa helper ;)
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    LR6SO4 & Simpleton, I'll be more than happy to hand over my extra 40 hours a week to you if they cut residency hours...I'd hate to see you miss out on valuable learning time...
    :rolleyes:

    I have to agree that residency hours DO need to be cut. Do I think they WILL be cut? Probably not. Maybe on paper, but I doubt the regulations will ever be enforced.

    I also must take issue with the offhanded "the way it is now..." comment. Just because things have "always" been that way, doesn't mean it's RIGHT! Otherwise, women wouldn't be able to vote (bet that would make ya happy, huh?), African-Americans would still be slaves, and jackasses like Bin Laudin would run everything...
     
  8. jimjones

    jimjones Senior Member
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    Sorry, I guess I'm just a god damned 'liberal', but I'm in favor of a restriction too. I think directors may be more interested in slave labor then training residents at times.
     
  9. Cassidy61

    Cassidy61 Senior Member
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    how many hours do you think the average surgeon in practice works per week? i know that it greater than 80 more times than not. how will you make a decision when you are tired and not used to working that long? are you going to say that no decisions can be made after 80 hours in a week??!! medicine is a life, not a job. i started this process knowing full well that i would have to endure a lot of sacrifice (sleep, relationships, etc..). if you don't like the rules of the game than don't sign up.
     
  10. simpleton

    simpleton Senior Member
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    My quote that you guys seem to love: "The way it is now is the ways its always going to be."
    How the hell can you compare this to woman gaining the right to vote or slavery. Damnit you can't compare this to slavery or woman voting because those obviously were wrong and unfair. Doctors busting their humps to do the right thing and further their knowledge to help others is light years different and you (Cobragirl) trying to compare them is a flawed argument to try to make. Doctors have been working long hours through their residency years for sometime and if you ask them they say it was a valuable learning tool. Sure I would love to work shorter hours but I know that more can be made and expected of me. If you are going to try to fight the system that is working fine (other than a minority of people bitching and moaning)then I don't know what to say other than there are always a few that are going to try to be rebelious. If you ask me which doctor I would rather have, either one who worked restricted hours or one who has absorbed much more via more hours, I would take the latter. Do what you want to do, I'm just saying I'm ready for the challenges that are awaiting and too bad for you sorry saps that are just to effing lazy and self-serving to make the most of it.
     
  11. LR6SO4

    LR6SO4 Senior Member
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    As the topic starter I guess I should qualify this a bit in regards to my own opinions. While the training might be adequate at 80 hours/wk as some have suggested, I really feel that it AMSA is taking this out of its territory for one thing, and also not thinking about the consequenses. AMSA lures in new members by offering free Netters or whatever and then makes their decisions look like the majority of students support them, most probably don't even know what they are about. The other point is that AMSA and residents? I don't see the connection there, until residents say something (I know some have, but not all) AMSA has no business invading their space.

    They also have not said where the extra help would come. Residents are cheap labor, but still pretty darn expensive for a hospital to replace. This would drive up costs and make health care less accessible...hmm..sounds like a precursor to NATIONAL HEALTH CARE!! bad bad bad
     
  12. jdub

    jdub Senior Member
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    i really don't know why some of you are so bent on this right of passage thing, but besides the danger that patients are exposed to by exhausted residents, there are many health risks associated with sleep deprivation that residents must face, which include complication with child birth, motor vehicle fatalities, and i am sure many others.

    there have been studies on this stuff, like this <a href="http://www.citizen.org/hrg/PUBLICATIONS/1570.htm" target="_blank">one</a>.

    as pointed out in the above article, it is probably unlikely that a resident learns something essential in their training during the 81st to the 120th hour.
     
  13. Neurogirl

    Neurogirl Resident Extraordinaire
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    Cassidy61 and Simpleton,

    What year are you? Have you started residency yet? NO ONE has any problems with the 80 hr work week. It's the 120 hr week that we have a problem with. Have you ever worked 120 hrs per week? It turns your brain to mush...I can assure you there's not a whole lot of learning going on. BTW, how many surgeons do you actually know? I know several and none of them average more than 70-80 hrs a week. I average 80 hrs per week and have no complaints. Although I have little time for family/friends, am always putting off personal errands and my bills are always late, there is still plenty of time for reading and sleep. I don't mind these sacrifices because I know it's part of the process. Also, at my hospital, there is alot of bedside teaching and didactic time. However, I have a friend who routinely works 120 hrs per week and is dying. She works and sleeps...that's it. Her didactics are a joke and her attendings are too busy to teach. She is being cheated. At least a third of her time is spent doing scut...not learning. She's learned so LITTLE that she's afraid of failing her boards. There goes your theory that more hours equal better training. From what I've seen and heard, the programs that are abusing the system do so because they are understaffed...NOT because they are spending 120 hrs a week teaching residents. These programs should be held responsible for their actions. Also, it's been shown that after 24 hrs a person is just as impaired as if they were legally drunk. BELIEVE me when I tell you that after 30 hrs straight (even at my program, calls typically last at least 30 hrs and they're so busy that we rarely get to sleep.) I dread making important decisions out of fear of doing something stupid. Residency is supposed to be about learning to care for patients and make critical decisions, not about providing the hospital with slave labor or finding out first hand your tolerance for sleep deprivation. These are the kind of issues we're talking about. :mad:
     
  14. simpleton

    simpleton Senior Member
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    For all you WHINERS and COMPLAINERS the answer is simple: CHOOSE A DIFFERENT CAREER. I apologize if I'm coming across harshly but I can't help but question career choices.
    You know full well what is ahead of you. So why then do you select that as a career? Do doctors have a huge responsibility??? OF COURSE! Does the training pay off?? YES! Does anyone successfull in America get there by not working hard? NO! Ask any CEO or accomplished individual how they got to their position and they will tell you that it was hard work. I don't think Bill Gates went to bed before 12 PM too many nights when he was geting his company off the ground. Yes residency is grueling and rigorous but it doesn't last forever. There is light at the end of the tunnel. Hang in there and develop a strong work ethic. Maybe myself along with other driven individuals are willing to give their all and not think twice. Being a physician is a huge responsibility and I just hope that everyone knows this before making the commitment.

    Why then do people pick a career to go into if you are going to fight key aspects of it? It seems a bit backwards.
     
  15. LR6SO4

    LR6SO4 Senior Member
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    Neurogirl,
    You bring up some good points about this, and thanks for sharing. It seems that is the most common argument for limiting hours. It's hard to disagree that 120 hours is too much, I know they are. I would still say that a law limiting it to 80 is nonsense though. For one thing, in a free market things should equilibrate and programs that are too harsh will be forced to change. Of course this only works for those with an excess of open spots...and things like neurosurg and ortho then become self-selecting, you go into it knowing that 120 is the norm. Another thing is that where does the extra labor come from? It's one thing to say lets change, a whole other to say how. Hospitals would have to either delegate the resident level care to LPNs (shortage of nurses and you would have to hire 3/1 resident to cover the same amount of work as they are unionized) or hire people with comparative knowledge (PA's?, cost a lot more).

    In the end I just don't like the way that it enables the government to say how long you can work. If you want to be a surgeon, you expect the hours. If not then maybe you weren't meant to be that. When someone comes up with a plan that makes sense and shows me how the work will be covered, I might reconsider. Until that, long live a free market system!
     
  16. LR6SO4

    LR6SO4 Senior Member
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    Simpleton,
    You've earned my utmost respect with that last post! Let me share a few key truths from the Dr. of Democracy that go along with what you said:

    There is a distinct singular American culture - rugged individualism and self-reliance - which made America great.

    The vast majority of the rich in this country did not inherit their wealth; they earned it. They are the country's achievers, producers, and job creators.

    Follow the money. When somebody says, "It's not the money", it's always the money.

    I am not arrogant.

    Evidence refutes liberalism.
     
  17. Neurogirl

    Neurogirl Resident Extraordinaire
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    I certainly don't have a better system, or know where the extra labor would come from. But I can tell you we're only talking about a minority of programs that are truly abusing the system. Most hospitals have managed to figure it out and the ones that haven't...well maybe they should go under, or find new management. Also, you guys still haven't answered my question. Are you in residency yet? I can assure you, your idealism will start to fade once you are in my position. You act like anyone interested in any changes to the current system is nothing but a lazy whiner unworthy of becoming a physician. That's bullsh#t. Nothing could be further from the truth. For example, I'm not supposed to work more than 80 hrs per week. Sometimes it comes out to more than that (this week I'll probably put in close to 100 hrs). Do I complain about it? Of course not, because I know it's not the norm, and I'm not being abused. No one is saying that residency should be anything less than the grueling rite of passage it has always been. We're only saying that there should be some limits and that the MINORITY of programs abusing residents should be held responsible for their actions. I've talked to a few program directors about this problem and they all agree...working your ass off is one thing, but working beyond the point of physical and intellectual exhaustion is nothing short of dangerous. Granted, most of these types of programs end up filling with foreign grads, but that's no excuse. I wouldn't want my Grandma cared for by someone in an abusive program. Well, I guess I've ranted enough. Thanks for letting me vent...I'm a tired resident.
     
  18. guardian

    guardian Senior Member
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  19. LR6SO4

    LR6SO4 Senior Member
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    Neurogirl,
    Thanks again for the insights. For the record I'm only a second year so I haven't experienced this firsthand yet. As to whether my idealism will fade...we'll see. After a 36 hour shift it just might. It already has, but this is part of just growing up. We all entered med school wanting to do general practice somewhere in an underserved area, right? Now a nice house in the suburbs sounds like a plan for me. I still think that a law is a bad idea, and you alluded to this...maybe just a system to report abuse to the AMA or something like that would work better.
     
  20. LR6SO4

    LR6SO4 Senior Member
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    guardian,
    You're right about residency not being a free market, and salaries would be higher if it were. I disagree that residents would form unions however...only a minority would I believe, the rest of us would not. My point was in trying to keep it as free market as possible. AMSA's bill is really just a ploy for nationalized health care though! Look at it, hospitals will be crying for money, G.W. just might follow his dad's one term post-war legacy when the approval ratings normalize again...and did you see the Dem. govenorships this week?

    Watch out for Hillarycare...coming to a country near you in 2004. AMSA is looking forward to this..if you don't agree with it then let someone know!
     
  21. ghostcow

    ghostcow Member
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    LOL, this is so funny. I'm a fourth year and have only done maybe 5 months with regular call with 100+ hours/week, Trust me it sucks. I admire the surgery folks, many who have been doing it for years but I don't think it is beneficial for the residents or for the patients. That should be the basis of the debate not the fact that it has always been done that way or that it will be difficult to change.
    Oh well, Peace.
     
  22. proffit

    proffit ovary mcnugget
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    LR6SO4 and Simpleton:

    How long are you going to ignore the question (asked of you multiple times) of what year of med school/undergrad/residency you are in?

    If you haven't done at least a year of residency, your opinions are meaningless to me.

    B
     
  23. Cassidy61

    Cassidy61 Senior Member
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    neurogirl-

    for the record, i am a fourth year med student going into a surgical subspecialty. i have experienced months at a time working for 100-120 hours per week and didn't really mind it. of course it wasn't wonderful, but i found that i learned more during this time than any other. (i assume that you are in neurology and not neurosurg??) i am prepared to work this many hours for years at a time. also, i know roughly 35 surgeons (general, neuro, ortho, etc..) and none of them work on average less than 80 hours per week in private practice. when you don't have residents doing your work (ie. academic center) then who do you think does it???? sounds to me like you are just a born whiner.
     
  24. lilycat

    Moderator Emeritus 10+ Year Member

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    Cassidy -- Ever wonder how many of the cases at an M&M are the result of fatigue-induced mistakes?

    LR6SO4, Simpleton, Cassidy -- I assume you all are aware of studies that have shown drowsy driving to be as dangerous as drunk driving, if not more so. How many of you think it's acceptable for a resident or attending to be drinking while they are on duty?
     
  25. lilycat

    Moderator Emeritus 10+ Year Member

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  26. simpleton

    simpleton Senior Member
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    I just wish you guys would quit your bitching and moaning. I hope you expect to work 120 hrs or whatever it takes to pull your weight. If regulations get passed that prohibit excessive work hours than so be it but it hasn't happened yet. If it doesn't happen I hope you are ready for what's ahead. :p
     
  27. Cobragirl

    Cobragirl Hoohaa helper ;)
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    I vote that the REST of us work 80 or so hours a week and we'll be generous and let LR6SO4 and Simpleton work the remainder (what the PA's wouuld cover!) of everyone's shifts. Since you guys seem so adament about working the hours...go right the hell ahead!

    Personally, I'd like to be able to go to the grocery store once a month and pay my bills on time. I certainly didn't come this far just to ruin my life for everyone else. I have no problem with the "rite of passage" either, but I can PROMISE you that after a 36 hour shift, I will be learning NOTHING except hated for whoever/whatever keeps me awake a minute longer!
     
  28. srlondon

    srlondon Member
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    I must admit that I'm getting quite a kick out of this thread. The bit about the 2nd yr med students who have never taken call trying to dictate residency hours still has my sides aching from laughing so hard.

    There are two kinds of apologists who are looking for excuses to preserve the status quo in US medical education: those who idiotically think that "more is better" and those who equate medicine with a military basic training obstacle course (a concept whose time has also come and gone, not incidentally). Both groups of individuals forget that our foremost duty is not in being slaves to the allmighty dollar or serving as a proving ground for quaint 19th century capitalist theory. Somebody should make up pins for med students, residents, and attendings that say, "IT'S ALL ABOUT THE PATIENTS, STUPID!"

    Anybody who thinks that they can function as effectively after 36+ hours without sleep as they can after even a minimal basal amount of sleep is full of crap, to be completely honest with you guys. Over and over again, well-designed studies show that sleep deprivation has a detrimental effect on a constellation of cognitive abilities that a gung-ho attitude and so-called experience with sleep deprivation have no bearing on whatsoever. Until some researcher creates the perfect med student (with the "sleep" gene knocked out, naturally), sleep is a fact of life. Would you pre-meds, 1st and 2nd years consider going into an important exam without having slept in two days? You'd be lying if you said that you'd do it by choice. And terms of med students in their clinical years, it's very easy to take call every third night during your AI/sub-internship or during a tough rotation when you know that next month you're back on a cushy schedule. Remember that that is a resident's entire LIFE for 3-5 years or more. You can do anything for a month, but like student loans, sleep debt only compounds each night and grows with time.

    The bottom line is that the powers that be as well as various and sundry fools within our midst persist on seeing things as they are rather than what they could be because a) they don't have the imagination to do otherwise and b) their primary interest is in maintaining the exclusivity of the "old boy's club".

    However, it is clear that there are many good alternatives to impossible solutions such as either importing residents from overseas en masse or doubling the number of medical schools in the US. In particular, the "night float" system, is quite a successful middle ground. This is a system in which the "normal" residents have limited call responsibility-- no more admissions after 7pm or so, after which point a "float" resident comes on call and handles admissions and orders until the next morning when the next team is on call. The "float" resident is someone who does an entire month of 7pm to 7am 5 days a week for a month. This way, the on-call team at least has a chance to finish up their work by 10pm and get a decent night's rest. The medicine residency program at my school has the improved board scores to show that this works.

    So I dare those who say that reform is "impossible" to actually think for themselves a bit and try to come up with some meaningful suggestions rather than throwing up their hands.
     
  29. SimulD

    SimulD Senior Member
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    Amen, brother!

    I'm just a measly first year, and I'm already trying to figure out why there are people that 'want' to do these ridiculous types of shifts. Why on earth would that be a learning experience? How can anything be a learning experience when you're probably hating every minute of it past 24 hours or so.

    But, I can see in some students - they are already hitting the 'Ripped Fuel' and whatever to stay up and study constantly, most of them get by on 6 hours of sleep or less a night, many of them never exercise (how do residents do that, btw, while working 120 hour weeks?), many of them have no significant life other than Netters, the lab, and exams ... and then the rest of us who sleep 8 hours, get some exercise, still read novels, still go to the bars, miss some classes, but still manage to learn a hell of a lot, at our own pace, without it letting it rule every aspect of our lives.

    It frustrates me when doctors or residents complain that they wished they'd done something else. I just think residents would have such a better outlook on what they have chosen if the darn process wasn't so malignant to begin with. It shouldn't be malignant. But it's funny, time (and more likely, money) seems to fade these issues. It seems when I ask some older physicians about these issues, they just say, "Oh, well we just got through it," and "No, we probably didn't make too many mistakes, at least nothing that wouldn't have happened even if he had slept." Baloney. I bet all those drunk drivers would have killed those people even if they were sober, right? Come on!

    It is all about the patients. I know that they'll be better off if we are rested (maybe not the 8 hours I get every night, but at least some sleep) and excited about the next day, rather than burnt out and dreading the next call shift, which is not many hours after the last one.

    And to anyone who says I'm lazy - well, I don't want to curse, so I won't - FUDGE YOU! I'm not lazy, I'm reasonable, and I know that I need to look out for 1) Me 2) Patients ... and the only way for that to happen is for me to be in top mental health and top physical health.

    But, on another note, I don't think the policy that is on the Hill right now is a great idea. It should be internally restructured; the only way that can be done is through cooperation of medical students, residents, and physicians, not lawmakers. They don't need to set any sort of hard and fast rules for us. This is medicine - a profession (one of the primary components of that definition is 'internally regulated') - it needs to be flexible and adaptable and fashioned by us. I think we should take it upon ourselves to create an appropriate training schedule and to lobby that the programs that we will soon train at. Because there is times when a longer than 24 hour shift is necessary, and there is times when a greater than 80 hour week will happen. We just have to have more common sense about the whole thing. How do we do it?

    Simul
    Tulane Med '05
     
  30. Homer J. Simpson

    Homer J. Simpson 1st and goal from the 1 yard line.
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  31. LR6SO4

    LR6SO4 Senior Member
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    Ok then, let's come up with a better plan! SimulD even said that he didn't agree with the bill, and someone else alluded to a night float system. What are some other options? I guess this is really at the forefront of my thoughts right now as the AMSA chapter at my school is going to invite Conyers (D, Mich.) over to show their overwhelming support for this bill and how all med students do too...I need some good responses from y'all here...I'll yell, scream, whatever it takes to say that yes there is a problem and NO this bill is not the answer!
     
  32. SocialistMD

    SocialistMD Resident Objectivist
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  33. immediate

    immediate Junior Member

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    The level of complaining is not really acceptable is it? Everyone in school now knew what they were getting into, and if you did not, then there are plenty of fields out there where you can have the flexible schedule you require.
    Many of you supporters of limiting work hours may be saying something like "But I want to help people, not just have a job." Maybe you have not heard of the nursing shortage going on out there. Nurses do great work and they help people a great deal. So if you want to control your hours and not get pushed to your limits of fatigue, then that is a great career choice.

    I am a fourth year student and I have witnessed the many great learning opportunities that can be had by simply being there. I do not need some politician or some group like AMSA (medical student association?)to worry about me and my fatigue.

    You may say "What about your patients?" Listen, every person should discover their limits and adjust their lives appropriately. If you work a 36 hour shift, go home and sleep. Make the sacrifices to be alert and functioning when you are training. Any place that forces you to work beyond that is probably not somewhere you want to train, and if everyone stops training there, they will be forced to change. That's how things get done.
    Now, quit whining and get back to work.
     
  34. simpleton

    simpleton Senior Member
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    Immediate you took the words from my mouth,
     
  35. GreatPumpkin

    GreatPumpkin Mystical Treatbringer
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    Hospitals should have to start paying residents for overtime that would stop the crazy hours quick. When residents are not the cheapest labor in the hospital changes will be made.

    The only way to change the practice is to make it financially or legally unrealistic. And, the legal method will not work unless it hits financially and threatens accredidation or medicare eligibility.

    Of course as a pathology resident most of this conversation does not apply. :) But, I see my classmates dragging along everyday.
     
  36. Neurogirl

    Neurogirl Resident Extraordinaire
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    You gung ho med students (you know who you are) are SOOOOOO amusing! You equate watching with doing, but nothing could be further from the truth. I pulled similar hours as a student and it didn't seem so bad, but as previous posters have stated, it's easy to work insane hours when 1) you're not the one responsible for lives and 2) you have less rigorous rotations awaiting you. Wait until you've done it month after month after month and patient lives are at stake. Are there a few super humans out there who thrive on the hours and pressure? Sure. Is it the norm to perform at your peak after 35 hrs? I think not. To imply that someone who is not superhuman is a whiner is nothing short of insulting. Remember, we're not talking about a persons' work ethic, we're talking about human physiology. If you were a patient, would you want your doctor making life and death decisions about your care if they were "legally drunk"? Research has shown that after 24 hrs without sleep, a persons' reflexes and decision making ability are equivalent to someone "legally impaired". Think about it. Maybe this discussion should have been reserved for interns/residents. As students you really know NOT where of you speak. Before you continue to call me a whining slacker, you might take notice of the fact that not a single intern or resident has posted to refute my opinions.

    BTW, someone disputed my estimation of the hours worked by the average surgeon. I stand behind my previous estimates. The general surgeons I know average 10-12 hours per day, and take call one week out of 5 (including weekends). If they work 20 hrs a day while on call (which only rarely acutally happens), that's still an average of 75-76 hrs per week...far from the 100-120 hrs per week estimated by one poster. :eek:
     
  37. Cobragirl

    Cobragirl Hoohaa helper ;)
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    Also, when you're a student, you can ALWAYS take a day off when you get burnt out!! You are never FORCED to study because someone's life depends on you.


    Oh, and from another prospective...

    If YOU had a patient come to you and say that they were working 100-120 hours a week, what is the VERY FIRST THING you would tell that patient???? YOU'RE WORKING TOO MUCH!!! Why is it any different for us??? DO they alter our genes while we're in medical school so that we are the ONLY humans on the planet that don't need a decent amount of sleep, exercise, and LIGHT? :mad: PLEASE! We are NOT superhumans, and I'm fully convinced we can learn AND have our "rite of passage" without working an insane 120 hours!
     
  38. lilycat

    Moderator Emeritus 10+ Year Member

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    I just find it amusing that the original poster of this thread, and one of the most adamant supporters of the status quo for residency hours is also asking about radiology residencies on the Rotations/Residencies forum... :rolleyes:
     
  39. Doc Holliday

    Doc Holliday Enzyme Regulators, Ride!
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    My local news last night threw in a "hook" for "dangerous surgeons" that forced me to sit through their entire diatribe before seeing a 5 second piece stating the British Medical Journal has a new article out on resident surgeons and call schedules. Here it is...

    <a href="http://www.bmj.com/content/vol323/issue7323/twib.shtml#323/7323/0/b" target="_blank">Surgeons' laparoscopic skills decline after a night on call </a> :eek:

    Surgeons show impaired speed and accuracy in simulated laparoscopic performance after a night on call in a surgical department. After 17 hours on call with a disturbed night's sleep, significant deficits in psychomotor performance occur. Factors connected to surgical work, such as emergency workload, stress, and emotional demands, may potentiate the effects of sleep deprivation. Grantcharov and colleagues (p 1222) assessed the laparoscopic surgical skills of 14 surgeons in training during normal daytime working hours and again at 9 30 am after a night on call with disturbed sleep.

    [​IMG]

    More fuel for the fire folks... dh
     
  40. Slingblade the Surgeon

    Slingblade the Surgeon Senior Member
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    You know, I think I remember reading about how ole Hippocrates himself had to work 120 hours a week to learn to be a respected physician. So let the age old tradition continue....NOT!!!
    Forever long hours may have been the thing when this stupidity began some 200 years ago or less, but they didn't have the rest of the rat race to contend with at the same time. They didn't have to sit in traffic to get to the hospital (they lived there) or screw with biochemistry (they had no clue), etc. So I believe that it is high time for medical education to evolve with the times and allow greater lattitude for the greater responsibilities and stressors placed upon us.
     
  41. Slingblade the Surgeon

    Slingblade the Surgeon Senior Member
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    Can I have an Amen?
     
  42. Hopkins2010

    Hopkins2010 Membership Revoked
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    Cassidy,

    You say we should just play the rules of the game and not complain. What if your hospital administration suddenly said "now you are required to work 140 hours/week and we are cutting your salary in half." According to your logic, you would be willing to accept this because its simply a rule of the game right?

    In general, all those who say it will be too difficult to implement any changes should remember that

    NOTHING WORTH DOING WAS EVER EASY.

    All I'm saying is that just because it will be difficult to change the system does not mean we should give up and throw our hands up. Somebody mentioned the long honored ethic of American ruggedness and self-reliance. I doubt that this ideal has anything in common with the notion of refusing to even tackle a tough problem because "its too tough to solve." Thats a distinctively UNAMERICAN viewpoint historically.
     
  43. LR6SO4

    LR6SO4 Senior Member
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    Ok, I guess this has gotten a bit out of hand and I didn't think it would go this way...but as someone has pointed out, I am interested in 'lifestyle' residencies: ophtho, path, rads, pm&r.

    My main point in bringing up AMSA is that they (we, whatever) are STUDENTS! I just thought that if things are that bad, and apparently from lots of posts they are, then residents will band together and fight for a bill of their own. When I get to that point I will decide for myself. Now if RESIDENTS get behind the AMSA bill in full force then my argument is done, fine, do it, they work too much and I will agree with them.

    And thanks for keeping it civil too, there was some good discussion here.
     
  44. Hopkins2010

    Hopkins2010 Membership Revoked
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    LR6,

    In that sense, I agree with you. Residents have not done enough, for whatever reason, to speak out on this issue. I know many of them have fears about getting shunned and delegated to menial duties if they speak out against their institution's practices.

    I think things SHOULD change, but I realize that nothing will change until the residents get a unified voice and are willing to take some risks in order to fight for something that many of them KNOW is the good fight. Until that happens, any changes to the system will be slight and superficial.
     
  45. Doc Holliday

    Doc Holliday Enzyme Regulators, Ride!
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    As much as I hate to say it, Baylor, some of us will be skiing in hell when it freezes over before that happens. I wish it would though.

    Just an odd thought... Ever wonder if the term "pimping" on rounds really originated from the fact that med sudents, interns, and residents are really just attending's whores? The long coats always seem to be seen traveling from bed-to-bed with their subservient harem.

    Besides... You know you've been down to pick up "misplaced" :mad: lab results and said to the tech on duty at 1am, "You come up with my crit and me love you LONG time!" ;) dh
     
  46. surg

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    Being a new member of this forum, I'm just getting caught up, so I apologize for responding late to this thread.
    The group will be pleased to know that the AMA is finally joining the fray on Work Hours and Work Environment reforms, however belatedly. In the last year, multiple reports were released by both the Resident and Fellows Section of the AMA as well as the Council on Medical Education. The general position has been to try to achieve enforcement of work environment and work hours through the ACGME and its Residency Review Committees. Having friends on these committees which accredit residencies (ever wonder who puts a program on probation? It's these people) they tell me that work hours is a major focus.
    The AMA also also pushed the concept of using the JCAHO which accredits hospitals to include work hours and conditions in its accreditation procedures.
    In the last meeting, the AMA has relented to the concept that legislation may be necessary at some point, although the general feeling is that this is a last resort.
    Why? Well, first and foremost, there is no evidence that 80 hour is the safe or "right" number of hours for any specialty, and it is highly likely that for some specialties it is ok, and for others it isn't. To help answer those questions, the ASM (Association of Sleep Medicine) has been starting up studies. Secondly, the AMA-RFS wants to ensure that in the cut back in hours, the education that residents are there for is not lost. If we are going to shorten hours, residents should be spending those hours taking care of patients and learning, NOT drawing blood and transporting patients. Without protections for the work environment to ensure education, it would be hard to support any strict limits on work hours. Third, a hard limit on hours is difficult to reconcile with most people's conception of the duty to the patient. In other words, we all agree that a surgeon should never walk out in the middle of a surgery when he or she reached the 80th hour assuming that the surgeon is able to continue on, the corollary is that, if at the 70th hour, they are unable to go on, they need to be professional enough to call in back-up or try to find someone else to take over. (For those of you who don't think this would ever happen, I assure you that it can and should!)
    So why not federal regulation? Well, basically, it is doubtful that any regulation, no matter how well constructed will ever be able to cover all the circumstances needed to take care of patients in the most _professional_ way possible, so by bringing it back into the profession and putting some teeth into the ACGME/RRC mechanism we might be able to achieve more precise regulation. For example, if each program's FREIDA file or ACGME file was annotated with the work hours violations of that program, pretty soon medical students would wise up, and avoid those programs (they already avoid the "malignant" programs and that's just on rumors!). Over time, programs would either have to justify the hours that they are requiring (e.g. the education is just outstanding) or ratchet down the hours. Either way, residents benefit.
    Finally, to address the question of a student group (AMSA) pushing this, I believe they have brought some valuable fire to this issue, however, it is difficult as some other posters have noted, to take a group, primarily made up of people who have not yet reached this stage in their training yet, seriously as the leader.

    For those interested in what the current rules by RRC's are and how well programs are complying and the improvement that is taking place with the new focus on hours, here you go.

    Appendix:
    Work Hours &#8211; Graduate Medical Education Directory, 2000-2001

    Allergy and Immunology (Revised 1996)
    ? No more than 80 hours of hospital duties per week when averaged over 4 weeks
    ? On average at least 1 full day out of 7 free of hospital duties
    ? On call in hospital no more often than every third night

    Anesthesiology (Revised 2000)
    ? 1 full day out of 7 free of program duties
    ? On average, on call no more than every third night

    Colon Rectal Surgery (Revised 2000)
    ? On average, excluding exceptional patient care needs, residents have at least 1 day out of 7 free of resident responsibilities
    ? On call in the hospital no more often than every third night

    Dermatology (Revised 1999)
    ? When averaged over 4 weeks, residents should spend no more than 80 hours per week in hospital duties
    ? On average, have the opportunity to spend at least 1 day out of 7 free of hospital duties
    ? On call no more often than every third night
    ? Opportunity to rest and sleep when on call for 24 hours or more

    Emergency Medicine (Revised 2000)
    ? 1 full day in 7 days away from the institution and free of any clinical or academic responsibilities
    ? While on duty in the emergency department, residents may not work longer than 12 continuous scheduled hours
    ? There must be at least an equivalent period of continuous time off between scheduled work periods
    ? A resident should not work more than 60 scheduled hours per week seeing patients in the emergency department and no more than 72 duty hours per week
    (Duty hours comprise all assigned clinical duty time and conferences, whether spent within or outside the educational program, including on-call hours)

    Family Practice (Revised 2000)
    ? At least 1 day out of 7, averaged monthly, away from the residency program
    ? On-call duty no more frequently than every third night, averaged monthly

    Internal Medicine (Revised 2000)
    ? When averaged over any 4-week rotation or assignment, residents must not spend more than 80 hours per week in patient care duties
    ? Residents must not be assigned on-call in-house duty more often than every third night
    ? When averaged over any 4-week rotation or assignment, residents must have at least 1 day out of 7 free of patient care duties
    ? During emergency medicine assignments, continuous duty must not exceed 12 hours
    ? Emergency medicine or night float assignments must be separated by at least 8 hours on non-patient-care duties
    Internal Medicine Subspecialties (Revised 1998)
    ? When averaged over any 4-week rotation or assignment, residents must not spend more than 80 hours per week in patient care duties
    ? Residents must not be assigned on-call in-house duty more often than every third night
    ? When averaged over a year, excluding vacation, residents must be provided with a minimum of 48 days free of patient care duties, including home-call responsibilities

    Medical Genetics (Revised 1999)
    ? On average, at least 1 full day out of 7 free of hospital duties
    ? On call no more often than every third night, except in the maintenance of continuity of care
    ? There should be adequate opportunity to rest and to sleep when on duty for 24 hours or more

    Neurological Surgery (Revised 1999)
    ? On average, excluding exceptional patient care needs, residents have at least 1 day out of 7 free of routine responsibilities
    ? On-call in the hospital no more often than every third night

    Neurology (Revised 2000) and Child Neurology (Editorial Rev 1999)
    ? Residents must be allowed to spend an average of at least 1 full day out of 7 away from the hospital
    ? Residents must provide on-call duty in the hospital, but no more frequently than an average of every third night

    Nuclear Medicine (Revised 1998)
    ? All residents should have the opportunity to spend an average of at least 1 full day out of 7 free of hospital duties
    ? Assigned on-call duty in the hospital no more frequently than, on average, every third night

    Obstetrics and Gynecology (Revised 2000)
    ? On the average, no more often than every third night
    ? On the average, at least 1 full day out of 7 away from program duties

    Ophthalmology (Revised 1999)
    ? When averaged over 4 weeks, residents should spend no more than 80 hours per week in patient care activities
    ? On average, have the opportunity to spend at least 1 day out of 7 free of patient care activities
    ? No more often than every third night

    Orthopaedic Surgery (Revised 1997)
    ? On average, excluding exceptional patient care needs, residents have at least 1 day out of 7 free of routine responsibilities
    ? On call in the hospital no more often than every third night

    Otolaryngology (Revised 1996)
    ? On average, at least 1 full day out of 7 free of hospital duties
    ? On call in the hospital no more than every third night, except in the maintenance of continuity of care
    ? Adequate opportunity to rest and to sleep when on duty for 24 hours or more


    Pathology (Revised 1989)
    ? On average, have the opportunity to spend at least 1 full day out of 7 free from hospital duties
    ? On call no more often than every third night

    Pediatrics (Revised 2000)
    ? A monthly average of every third to fourth night for inpatient rotations requiring call
    ? Call may be less frequent for outpatient or elective rotations
    ? Call-free rotations should not exceed 4 months during the 3 years of training
    ? A monthly average of at least 1 day out of 7 without assigned duties
    ? Emergency department shifts should not exceed 12 hours, with consecutive shifts separated by at least 8 hours

    Physical Medicine and Rehabilitation (Revised 2000)
    ? Residents at all levels, on the average, should have the opportunity to spend 1 full day out of 7 free on inpatient and outpatient care duties
    ? On average, should be on night call no more often than every third night

    Plastic Surgery (Revised 1994)
    ? On average, excluding exceptional patient care needs, residents have at least 1 day out of 7 free of routine responsibilities
    ? On call in the hospital no more often than every third night

    Preventive Medicine (Revised 2000)
    ? When averaged over 4 weeks, residents should spend no more than 80 hours per week in all duties
    ? On average, have the opportunity to spend at least 1 day out of 7 free of hospital duties
    ? On call no more often than every third night
    ? Adequate opportunity to rest and sleep when on call for 24 hours or more

    Psychiatry (Revised 2000)
    ? One day out of 7 free of program duties
    ? On average, on-call duty no more than every third night

    Radiology-Diagnostic (Revised 1998) and Subspecialties (Revised 1994)
    ? Allowed to spend at least 1 full day out of 7 away from the hospital
    ? Assigned on-call duty in the hospital no more than, on average, every third night

    Radiation Oncology (Revised 2000)
    ? Residents be allowed to spend, on average, at least 1 full day out of 7 away from the hospital
    ? Not be assigned on-call duty in the hospital more frequently than every third night

    General Surgery (Revised 1998) and Subspecialties (Revised 1996)
    ? On average, excluding exceptional patient care needs, residents have at least 1 day out of 7 free of routine responsibilities
    ? Be on call in the hospital no more often than every third night
    ? Distinction must be made between on-call time in the hospital and no-call availability at home and their relation to actual hours worked


    Thoracic Surgery (Revised 1992)
    ? Duty hours and night and weekend call for residents must reflect this concept of longitudinal responsibility for patients by providing for adequate continuity of patient care. At the same time, duty assignments must not regularly be of such excessive length and frequency that they cause undue fatigue and sleep deprivation
    ? On average, excluding exceptional patient care needs, residents have at least 1 day out of 7 free of routine responsibilities
    ? On call in the hospital no more often than every third night

    Urology (Revised 1996) and Pediatric Urology (Revised 1998)
    ? On average, have the opportunity to spend at least 1 full day out of 7 free of scheduled hospital duties
    ? On call in the hospital no more often than every third night, except for the maintenance of continuity of care

    Transitional Year (Revised 1999)
    ? In-hospital duty hours shall correspond to the program requirements of the categorical programs to which the transitional year resident is assigned
    ? Distinction must be made between on-call time in the hospital and on-call availability at home vis-?-vis actual hours worked
    ? On average, excluding exceptional patient care needs, residents have at least 1 day out of 7 free of routine responsibilities
    ? On call in the hospital no more often than every third night

    Source: Graduate Medical Education Directory, 2000-2001

    Appendix 2


    ACGME
    NUMBER OF PROGRAMS AND INSTITUTIONS CITED FOR WORK HOURS AND RELATED REQUIREMENTS FOR YEARS 1999 and 2000


    Specialty % Progs Cited1999 %Prog Cited2000
    INSTITUTIONAL REVIEW 20.0% 8.0%
    Allergy and Immunology 22.0% 8.0%
    Anesthesiology 2.0% 2.0%
    Colon and Rectal Surgery33.0% 6.0%
    Dermatology 7.0% 0.0%
    Emergency Medicine 10.0% 6.0%
    Family Practice 13.0% 8.0%
    Internal Medicine (Core)30.0% 10.0%
    Subpecialties 4.0% 2.0%
    Medical Genetics 6.0% 0.0%
    Neurological Surgery 10.0% 5.0%
    Neurology 14.0% 14.0%
    Nuclear Medicine 0.0% 0.0%
    Obstetrics and Gynecology19.0% 5.0%
    Ophthalmology 13.0% 0.0%
    Orthopaedic Surgery 29.0% 10.0%
    Subspecialties 10.0% 4.0%
    Otolaryngology 10.0% 3.0%
    Anatomic and Clinical Pathology
    20.0% 2.0%
    Subspecialties 6.0% 2.0%
    Pediatrics 21.0% 16.0%
    Physical Medicine and Rehabilitation 12.0% 12.0%
    Plastic Surgery 10.0% 10.0%
    Preventive Medicine 0.0% 0.0%
    Psychiatry 0.0% 0.0%
    Radiology-Diagnostic 0.0% 1.5%
    Radiation Oncology 0.0% 0.0%
    Surgery-General 36.0% 35.0%
    Vascular 17.0% 9.0%
    Pediatric 53.0% 44.0%
    Thoracic Surgery 16.0% 21.0%
    Urology 8.0% 2.7%
    Transitional Year 24.0% 23.0%

    5/9/01

    Source: <a href="http://www.acgme.org," target="_blank">http://www.acgme.org,</a> accessed June 25, 2001
     
  47. LR6SO4

    LR6SO4 Senior Member
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    surg,
    Excellent post, I have been trying to get the same points across for some time now but you went and dug out some numbers. From a quick review of the recommendations already posted by you it seems that the AMSA-Conyers law, if passed, would simply enforce what is already there for most specialties. That is what I am going to have trouble arguing with Conyers when I meet with him in January. If you look at 'other' specialties however, just about anyone with a knife (except ophtho) doesn't have the 80 hrs clause in there right now. So this will be some good stuff for me. I really just want to tell him that this law, even if it is a good idea or whatever, is too early. There are no alternatives presented for funding those extra hours, no guarantee that a surgery resident could meet all procedures to graduate, and that damn "no moonlighting after 80 hrs" thing just gets to me. Thanks anyways, any suggestions as to what you would like Conyers to hear?
     
  48. Tazdoc

    Tazdoc Member
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    I saw this post by an SDNr. It seems to be rather insightful. What do you guys think?


     
  49. Tazdoc

    Tazdoc Member
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  50. LR6SO4

    LR6SO4 Senior Member
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    Read the bill! This is just an attempt by AMSA to cover some stuff up here. Here is what Conyers' web page says, pretty interesting comparing it to what you posted there about what AMSA says...
    <a href="http://www.house.gov/conyers/news_patientsafetyprtectionact.htm" target="_blank">http://www.house.gov/conyers/news_patientsafetyprtectionact.htm</a>

    "Many residents sometimes &#8216;moonlight' - work at other hospitals to supplement their income. This bill would require that residents notify their hospitals of such employment, and prohibit moonlighting if it results in a work week exceeding eighty hours"

    and now this is just funny. Losing credentials not serious?!
    "The ACGME, the accrediting organization for residency programs, is ill-equipped to deal with this problem. If they find a hospital in violation of the lax hour limits that do exist, their only recourse is a letter of citation or full accreditation withdrawal. Neither remedy is satisfactory."

    "Currently, the bill provides funds to cover the cost of hospitals hiring additional ancillary staff. These funds would only raise health care costs a minimal .002%"

    now here's what the text of the bill says regarding funding. It can be seen that, sure the bill provides for it. How? They don't know either. It's just there, no plans, just if it passes it will be there. Umm...yeah.
    SEC. 4. ADDITIONAL FUNDING FOR HOSPITAL COSTS.

    There are hereby appropriated to the Secretary of Health and Human Services such amounts as may be required to provide for additional payments to hospitals for their reasonable additional, incremental costs incurred in order to comply with the requirements imposed by this Act (and the amendments made by this Act).
    <a href="http://www.theorator.com/bills107/hr3236.html" target="_blank">http://www.theorator.com/bills107/hr3236.html</a>
     
  51. cheech10

    cheech10 Member
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