Are you working more than 80 hours?

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jstraziuso

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I'm a journalist for the Associated Press and am writing a national six-month anniversary story of the ACGME rules. I've heard a lot about how some programs aren't following the four duty hours rules, but it's mostly been secondhand so far.

I wonder if there's anyone out there who's working a ton, in violation of the rules, who is interested in having their story told. Given the reprecussions that residents would face for coming forward, I'm in a position to be able to report your story without using your name.

I already have one resident speaking on the record about duty hours violations, but I'm interested in hearing more stories, even if it's not for name attribution.

My email address is [email protected] and my cell phone number is 215-313-8730. You can verify my position in the news business by searching on news.google.com for the name "Jason Straziuso."

Thanks -- Jason
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Hey Jason,

I am glad to see you are interested in residents working condition, But I must caution residents turning their program info to you. While you will try to with held their ID , you can not guarantee no repercussion. You see if their program gets in trouble because of this. You bet your ass they will find out who turn them in, and they always do. They also alienate themselves in the program. Other residents will suffer the ACGME sanction too.

I know the violators are the programs and not the residents, but they should solve with in the program by having resident and program director meetings.

Unless, you can guarantee them safe passage in their specialty or future earnings compensation, if they end up losing their job (most of the time these residents are not fired, but they quit because everybody in the program hate them).

So be careful....
 
Been There,

You bring up some excellent points. A rebuttal: First of all, if anyone was to contact me, I could guarantee that THAT PERSON or THAT PROGRAM would not be identified. Because this is so sensitive, the source will determine how many identifying characteristics I can print. Wants to remain gender neutral? Fine. Perhaps I can identify the hospital but not the program, or I can only identify the city the hospital is in, or the state, etc. I will need to verify that the resident is who s/he says s/he is, but journalists go to jail before they reveal to anyone other than their immediate editor what a source's identity is.

Second, and perhaps a more important point: the disincentives for reporting violations. AMSA president Lauren Oshman is very adament that ACGME's reporting procedures have a lot of disencentives built in. First a resident would ostracize oneself, next s/he would render their education much less valuable. Can't get a job if your program isn't accredited. Point taken. But it's not likely that my story is going to send ACGME swooping in. I've spoken with ACGME officials, and they readily acknowledge that there are programs out there still not in compliance. They've gotten several dozen complaints from residents from their web site forms. THey know what's going on. And Johns Hopkins is a good example that sanctions wont' cause lasting damage. Hopkins already has accredidation back, and that will be long forgotten when it comes to hiring time. If anything, the whistle blower helped the situation ... as far as we know. Granted, that person is no longer in the program, but from what I hear, she or he has landed on their feet and is doing quite well in another program that abides by the rules.
 
An interesting point: many residents prefer to work two 120-hour weeks, followed by a fifty-hour week, instead of four 80-hour weeks. This has kept many individuals from reporting programs not in compliance.
 
And don't forget the other side of the story - many residents, especially those in some surgical specialties - are not in favor of the work hour restrictions. It has honestly caused more trouble than it's worth in my program. I'm all in favor of a day off a week and optimizing our time to get us out of the hospital at a reasonable hour, but setting an arbitrary 80 hour limit is often impractical. My faculty hate the work hour restrictions, as do the majority of my fellow residents. Last year, prior to the restrictions, I never saw a patient harmed by a tired resident. I've lost count of the number of missed injuries and other mistakes occuring this year because we have to limit our time in the hospital. I really think the patients are at greater risk now than before all this was started.
 
Dr. Elliot Sussman, chief executive of Pennsylvania's Lehigh Valley Hospital who also chairs a board of teaching hospitals for the Association of American Medical Colleges, said when he was a resident in 1977 he had to work "black weekends," from 7:30 a.m. Saturday until Monday evening ? 60 hours.

"That doesn't happen anymore," he said. "We want (trained) professionals, but we also want humanistic physicians."
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I have friends in NYC that still do this fairly regularly...
 
Well, at least for me, I now know the name of the whistle-blower (and know his picture) at Johns Hopkins that everyone was so hotly debating about here on this forum several months ago.

Dr. Troy Madsen.

Well, I say to Dr. Madsen, thank you for sticking up for your principles and I am sorry to hear the work environment became so hostile at Johns Hopkins that you had to leave. I hope you find new joy in your residency at Ohio State.

Also, to Mr. Jason Straziuso: you need to be very careful when researching those facts. The event in NY in 1984 was NOT due to overworked and under-rested residents. The case you refer to, that of Libby Zion's death, ocurred to due her failure to be honest about her illegal substance intake and due to a serious lack of supervision by senior medical personnel over her care. As with many preventable deaths in medicine, it was a multi-factorial issue, but it got the bully pulpit from her father who was a prominent figure in NY.

Also, those NY laws haven't changed a damn thing. If you want to, you will find these abuses in every field. It's a part of human nature that superiors want to find ways to buck the system.

Mr. Strazuiso, I wished your article delved more into the strange reasons why there are DISINCENTIVES to report these kinds of abuses (which are quite similar to the "Blue Wall of Silence" about reporting unethical/criminal behavior among medical colleagues). You don't really see this in any other profession like law or business, but because of the traditional design of our medical education system (based on an old German model adopted by Osler at Hopkins around the turn of the century) it happens that the person most put in jeopardy for reporting is... the resident.

The resident stands to suffer for loss of accreditation of a program, for bad evaluations by superiors who find out, for losing meager pay while being billed at a physician's level.

Report on these things, Mr. Strazuiso, delve a little deeper and bring it to the public's attention.

misfit
 
Originally posted by misfit
Also, those NY laws haven't changed a damn thing.
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By whose reckoning? When I did prelim-IM last year (in NYC), the medicine office would call us at 9:30am, and TELL us to leave - and find us and push us out the door. We had to sign an agreement at the beginning of the year that, if we were intentionally over the limit, it was our fault (and we could be fired). Everyone worked on keeping their hours down.
 
This quote from your article:
"A first-year resident at Baltimore's Johns Hopkins Hospital, Madsen was on hour 32 of a 34-hour shift when he failed to make sure a crucial blood test was given to a heart patient"

Okay ANYONE who has ever been in the first few days of their new job is bound to make a mistake - ANYONE in ANY profession. This mistake could have been made on hour 1 of a busy day - I think it had much less to do with Madsen being 32 hours on duty and much more to do with him being a first year resident in his first month. Residents have over 100 little tasks to do each day and the ability to prioritze them all and take care of each and every one of their patients in a timely fashion (with constant distractions and interruptions from the pager with more questions and more tasks to handle) is a learned skill not mastered in the first month of residency whether you work 40 or 140 hours a week.

To all these lawyers who have forced us into these arbitrary work hour rules: did you not make one mistake in your first few months of your first law job???? Did you sue your employer?

Doctors are people and yes, people need rest...but people also should take some responsibility for their own mistakes and not blame it on their program for making them work 32 hours, when we all knew darn well when we signed up for med school that this is part of the training system. I'm all for some of the reforms in work hours, but I can't say I am in support for a resident busting his program because he made a mistake of inexperience.

These rules came up just last year and became official this year, giving programs very little time ot figure out how to make this work. It's scary to residents that we may loose our programs if we aren't in 100% compliance in year one of these rules - give us a break while we all figure out how to change the system in one year with the same amount of workers doing the same amount of work in 20-40 less hours a week! It's a hard task to be done that quickly.
 
"It was my first week in residency, and the whole thing was just overwhelming," he said.

Another favorite quote from the article - whose first week of residency wasn't overwhelming???? Changing the hours won't change that feeling!
 
fourthyear-

AMEN!!!! to everything.
 
Fourth year:

You may be right, but I think it is hasty and dangerous to run with your assumption that Dr. Madsen made his error because of his inexperience or pressure while on the job the first week.

What IS known is that Dr. Madsen had NO business being in the hospital that long per shift. Yes, we are human, so let's start accepting some human limitations. To consistently ask residents to work these INHUMAN shifts is not right and we are just barely started to shift the massive inertia of a very tradition-biased profession in favor of doing things based on common sense and scientific reasoning (that includes more than just work hours, but also practice guidelines, evidence-based medicine, etc.)

You ask that the residents hold themselves responsible for their actions. Dr. Madsen did. He reported his mistake. Now, why couldn't the program directions/administration take responsibility for their failure to keep in check with the 80 hour work week rules. Your explanation, fourthyear, that we knew this when we signed up is NO EXCUSE for continuing this type of system.

If you would like to know of me personally, I don't always agree with using political action (either govt or admin bodies of professions) to solve these problems, but Medicine would not change it's ways otherwise-- too many chances were squandered over the last two decades.
I also don't mind working hard, but I am here to learn my profession, not be cheap labor nor have my rights ignored by those in power.

Keep posting your opinions everyone. This issue is paramount to our profession and there are many sides to it.

misfit
 
Originally posted by Apollyon
By whose reckoning? When I did prelim-IM last year (in NYC), the medicine office would call us at 9:30am, and TELL us to leave - and find us and push us out the door. We had to sign an agreement at the beginning of the year that, if we were intentionally over the limit, it was our fault (and we could be fired). Everyone worked on keeping their hours down.
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Misfit, you overstate your case, but Apollyon is not entirely right either. The situation you describe Apollyon was a result of attempts (finally) at enforcement of the Bell Commission Regulations in anticipation of the 405B ACGME regulations. The Libby Zion case did help some, but by and large most hospitals did not bother to follow the Bell Commission regulations that resulted, especally in surgery. It wasn't until NYU and Mt. Sinai were fined by NY State about 3 years ago that they began to change things, nearly 20 years after the Zion case.

Misfit, to say that the Zion case was not at least partly affected by the fact that 2 residents had responsibility for nearly 100 patients and were on a 36 hour shift, and then arguing that Madsen had no business being in the hospital for so long at a stretch, seems contradictory to me.

I went through the old way of doing surgery, and frankly I think that with some fine tuning it can work out fine. No need to make arbitrary limits on maximum hours. The problem was that people just dumped things on residents that had no training value, and made no allowance for the fact that people do reach a point of overload. If it takes an 80 hour restriction to reduce hazing and cut BS, then so be it; our predecessors (attendings) brought it on all of us with their selfishness.
 
No, I am right, because that is what happened. We logged our hours, the HHC kept track, and they would give us the bum's rush out of the house. This was 2002-2003. I was not speaking of earlier times, because I don't know about them.

I never heard about NYU and MSH, but I do recall SUNY-Brooklyn getting tagged for $250K in late 2000/early 2001 for duty-hour violations.
 
LOL... I was addressing your response to misfit's claim that the Bell Commission Regulations were ineffective, not the facts of your experience. Your posts indicated that you believed that the Bell Commission regulations were directly responsible for what you experienced in 2002-2003, which is not entirely correct.
 
There is no reason whatsoever to work inhumane hours as a doctor. We did not go to 4 years of college and 4 years of med school to be basically used as cheap hospital labor. It's sad when some residents apologize for and defend the system that treats them like salaried slaves. Somewhere along the line they were told that working long, exhausting hours during residency would make them more competent physicians...and they bought it. As long as you justify being exploited by the hospital, then the hospital will continue using you for cheap labor while telling you it is actually for your your own good since it will make you a better doctor...B.S. Don't be another "happy slave".
 
Originally posted by 5oProlene
Somewhere along the line they were told that working long, exhausting hours during residency would make them more competent physicians...and they bought it. As long as you justify being exploited by the hospital, then the hospital will continue using you for cheap labor while telling you it is actually for your your own good since it will make you a better doctor...B.S. Don't be another "happy slave".
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:thumbup: Thats exactly what pimps tell their hoes, to go work their butts off and that it is for their own good, but biatch better go make me my money. Some people just love being exploited.
 
Typical inflammatory comment from our molehill to mountain media:

"Madsen was on hour 32 of a 34-hour shift when he failed to make sure a crucial blood test was given to a heart patient."

A test is NOT given to a patient. A test is a method of obtaining data FROM a patient. Its such a small word choice, but it implies a conculsion that is worse than it probably was. It actually implies the patient didn't GET something (an intervention, which a test is not) that could have prevented further M&M. Pure sophistry. And the word choice is clumsy, "test was given" doesn't have an elegant ring to it. Makes me think its intentional.

What was it, probably a K of 3.2? Or the second positive troponin? Would a management decision have been affected by this data?

In this discussion, which I feel is very important, I think we need to take more care with our words. Obviously, people, as above, try to build up the fire of public opinion so they can sell more advertisements for soap, dell laptops, and underware. I'm not sure that's something we want.

For those of you who work more than 80 hours: I say to you, "have a nice day, slave." For those of you who work harder and with more agravation and are covering more patients and work less than 80 hours: I say to you, "have a nice day, slave."

Later.
 
Boy you guys know so much, why weren't you around to share with all of us your incredibly simplistic and obviously uninformed opinions earlier? Could have saved all of us so much trouble. :rolleyes:
 
From todays AMSA Health and Policy Headlines, a local-flavor version of the AP article being debated:

**AMSA in the news**
Local medical residents buck hour trend (Marshfield News Herald)
http://www.wisinfo.com/newsherald/mnhlocal/282086437040144.shtml
Using excerpts from the Associated Press article, the newspaper reports that administrators at the University of Wisconsin Family Practice Program, which has residents working in the Community Health Care clinic system, and at Marshfield Clinic in Marshfield, which places some residents at Saint Joseph's Hospital, found that residents in their programs were largely in compliance with the 80-hour rules before they went into effect in July.

The programs mentioned are http://www.marshfieldclinic.org/education/residency/ and http://www.fammed.wisc.edu/education/residency/wausau/wausau_overview.html

Has anyone else seen local flavor versions of this AP article?
 
you people are absolutely ridiculous.

you claim that working 30 or 40 hours straight poses NO risk to patients at all, when you KNOW thats a blatant lie.

Its common sense and arithmetic people. I guess you same fools would also say that pilots and truck drivers could also work for 40 hours straight with no ill effects.

And before you get all high and mightly in your ivy league towers making claims about how "we are better than pilots or truck drivers, we're DOCTORS DAMNIT!" please take a breath of fresh air and realize you are NOT all that.

Are there also extra risks involved with extra shift changes? Absolutely. But these risks can be DRASTICALLY REDUCED BY PROPER PLANNING AND INTEGRATION. Lack of sleep CAN NOT BE MODULATED IN ANY WAY.

Some of you fools are using the excuse that "having shift changes is dangerous to patients" when you really dont give a damn about patients, you are on some acid trip thinking that since you're a so-called doctor, that you are better than everyone else and can handle any amount of work hours.
 
As usual, MacGyver is ridiculous and inflammatory.

I get sleepy driving my car for 3 hours, let alone 30 or 40. The problem is the monotony. Driving a car or a plane cannot be directly compared to taking care of patients in a hospital because taking care of patients is anything but monotonous.
 
Originally posted by Linie
As usual, MacGyver is ridiculous and inflammatory.
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I made the pleasant discovery earlier today of the "Edit Ignore List" button on the User Control Panel - type in someone's user name & you'll never have to see their flames on the SDN again!

:clap: :clap: :clap:
 
Hi Dr. Doom, thanks for responding to my post. It is possible that I may be overstating my case, sometimes I have a penchant for hyperbole.

Still, I do stick by what I said of the Libby Zion case: it was NOT that the residents were tired. As you even note in your reply, they had way too many patients to cover and they were not properly supervised.

So, mistakes were made in the timing of Zion's care (along with her failure to note her drug abuse) and it went from bad to worse.

I am not a fan of mandatory work hours or much of anything mandatory. However, the system proved it would not change to benefit its trainees or the patients, so someone had to enact some sort of enforcement. God help us all if it become the federal govt.

I would like to hear more of your thoughts, Dr. Doom, you appear well-read and well-spoken.

misfit
 
Originally posted by Dr. Lector
:thumbup: Thats exactly what pimps tell their hoes, to go work their butts off and that it is for their own good, but biatch better go make me my money. Some people just love being exploited.
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I think it has a lot to do with how so many (i.e. most) med students are complete sheep and will do whatever their medical school, and subsequently their residency, tells them to do. If they say you're going to work 36 hours straight, then most residents will do it without question. Not so much that they think working 36 hours straight will make them a better doctor, but because they want to have their place in the herd. And if one of their own speaks out about the B.S. going on like the resdient at Hopkins did, then they'll ostracize him since he is no longer a sheep. Sad really...
 
Originally posted by Linie
Driving a car or a plane cannot be directly compared to taking care of patients in a hospital because taking care of patients is anything but monotonous.
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Oh bull****. You and I both know that residency involves a lot of time when you are hunting down lab results and doing stuff that has very little to do with active patient care.

Things like sitting down and doing boring paperwork, hunting down lab results, waiting on imaging studies, reviewing orders, and holding retractors in teh same position for 5 hours straight while famous Doctor X does all the good stuff.

You're not fooling anyone with that crap about how everything you do during a 36 hour shift is fun and interesting, cause everybody here knows you are lying about that.

Your the same person who demonized the guy who ratted out on Hopkins, your the same person who said that Hopkins was NEVER in violation of anything, you're the same person with the stuck up attitude that because its Hopkins, that they are above the rules.

You and your program need a reality check. Hopkins is NOT all that. Tell Charles Wiener, David Nichols, and Edward Miller that we dont believe their lies.

Tell them to stop lying about Hopkins following the ACGME regs and pretending to be in compliance the whole time when they knew DAMN WELL they were not following the regs. Tell them to quit crying and bitching about how Hopkins is supposedly being treated unfairly. Tell them that they are NOT all that, and that they dont get "brownie" points just because they're Hopkins.
 
Originally posted by MacGyver
Oh bull****. You and I both know that residency involves a lot of time when you are hunting down lab results and doing stuff that has very little to do with active patient care.

Things like sitting down and doing boring paperwork, hunting down lab results, waiting on imaging studies, reviewing orders, and holding retractors in teh same position for 5 hours straight while famous Doctor X does all the good stuff.

You're not fooling anyone with that crap about how everything you do during a 36 hour shift is fun and interesting, cause everybody here knows you are lying about that.
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It's true, it's true.

A lot of those 36 hours is taken up by mundane activities that do not require a medical degree to perform. Do not fall prey like most of the med students and residents out there have that working long hours is necessary in order to make you a competent physician. Residency programs need you to believe this old line in order to keep you working those hours. Who in their right mind believes that waiting for x-rays, transporting patients, and doing secretarial paperwork will make them a better physician? It's all about utilizing residents as cheap labor under the premise that it is of educational value.
 
5oprolene,

you are right. Shortly, though Linie and her ilk are going to come back on here and procalim that at Hopkins, they dont do paperwork. That at Hopkins, everything you ever do is a valuable learning experience based on patient care. That at Hopkins, every waking moment is spent learning an advanced procedure that other programs dont give you access to.

Linie's whole spiel on this thread has been about how Hopkins is supposedly special and different than all other residency programs. I GUARANTEE YOU she is going to come back here and make up some more BS about how at Hopkins, they operate differently than every other residency program in the country. Of course, she cant pull that crap on me, because I know personally a couple of the IM residents on the Osler service.

you and I both know its bull****, and that Hopkins operates very similar to other residency programs in using their residents for cheap ass labor that often has nothing to do with learning or helping patients.
 
It doesn't matter where you are, whether it be Hopkins, Harvard, or Buckwheat Medical Center---there is no justification for working exhaustive shifts. Even if you are doing activities directly related to your education or patient care, there is no real viable reason you should be doing them when you are extremely tired. Residents go along with it and suffer through it because they operate under the assumption that they have to since they are the low-man on the proverbial medical hierachy and that it is part of medical "culture" and a "rite of passage"...and all that B.S. they believe just because they were told it is just the way it has always been. Medicine has always been a very conformist profession and stuff like this just propagates it. But if more and more residents started standing up for themselves and not just sheepishly going along with being exploited then the system would gradually change. It's great that we've finally got an 80-hour rule going, but we need more. 80 hours is still too much. You can train to be a competent doctor in less time if all the unnecessary garbage was taken care of by people who weren't training to be doctors.
 
Damn misfit, how am I supposed to be a crotchety old man when you are so polite? ;)

I think you guys are seeing only one side of the issue. You need to give you fellow medical students and other residents some credit. it is not just because they are sheeple that they do the long shifts. There are good reasons why residency can be so time intensive. No doubt much of it has degenerated to hazing and regimentation, but even the "unnecessary garbage", Prolene, are critical to patient care. Seeing a CT as it comes out with the radiologist is a learning experience. Doing your own blood smears can also be instructive. Not all the time, but don't be too dismissive.

Residency is a social activity steeped in tradition. It has good and bad. The long hours aren't entirely arbitrary, nor is it possible simply because current students and residents (who have very little power, mind you, put up with it.

The following is something I wrote to explain to some military guys why residency is, in their words, a suckfest. I hope it presents a bit of the other side. I think change was and is necessary, but the system was the way it was for some some good reasons. Somewhere along the way we became just cheap labor, and much of the apprenticeship aspect of actually being taught was lost. I blame medical education leaders and attendings for this, and think the solution still lies there. Anyway, it's long, but read the info below and try not to be too judgemental of your fellow students, everyone.

The gruelfest, as you and Col. XXXXXX noted, is similar to Ranger training in certain cultural aspects. It is partially tradition, partially hazing, partially good training technique, and partially economics.

Halstead, the father of American surgery residency training, learned much from the Prussian military hospital system. To a certain extent he recognized that strict hierarchy and discipline in an extremely limited (in the days before reliable anesthesia) field that required a good deal of brutality and a certain ruthlessness, required a rigid social structure to maintain order. Many of his practices still form the basis of all residency training. Medicine being a conservative (some would say clannish) profession, these attitudes persist.

These social conditions tend to attract some very controlling personalities, and thus tradition evolves easily into hazing, or at least an attitude of "I went through it, you do it too." And it is bad form if a patient is suffering and a senior attending is trying to teach you, if you say "Well, it's 5 o'clock. I'm going home because my shift is over." An ambitious or caring young doctor would never do that. Before the days of evidence based medicine and medical imaging, and even long after it, the clannish approach of imparting medical knowledge at the bedside, learning as an apprentice to the master, was seen (and is still seen sometimes) as the best way to learn. Much of common practice is now being questioned as people use large studies to evaluate treatment decisions, rather than the usual standard of "Well, my Chief resident did it this way, so it's good enough for me." Woe betide anyone who questions the Gods of Medicine and the word from on high!

Fortunately, much of the foolish and malignant aspects of residency training are passing on. In most residencies people recognize that treating educated, caring adults as human beings is a good idea. Also, most doctors do not need to deal with dire emergencies, and so long as they recognize that a patient needs acute help, they can send an ambulance and enlist the aid of experts. So a reasonable exposure to exhaustion and emergent cases is sufficient.

Surgery is a bit different because the act of treatment itself is a brutal assault on the body. I have to make you unconcious, suspend your ability to breathe for yourself, cut you open with a scalpel, do some funky stuff, then sew you closed with a needle and thread. In essence, every decision comes down to whether that assault is truly necessary or not. Thus the ability to deal with stress and think clearly at all times of the day is required. Interestingly, we used to say that surgery is about attention to detail, a watchphrase have seen used often in elite military circles as well. (not equating the two) Traditional teaching states that 90% of post-operative complications can be directly traced to technical failure in the OR. I have to know internal medicine/ pediatrics/ OB-GYN/ radiology etc. to diagnose the patient and assess the need for surgery, know all that information in order to support the patient during and after the surgery, know the technical aspects of performing the procedure, and be able to do it as well at 9AM after a good night sleep or at 3AM on no sleep at all; surgery has a way of frustrating schedulers and lasting longer than anyone expected. So making surgeons train the way we have to practice is a very good idea.

When a patient walks into the emergency room, and says to me "my stomach hurts," it is often 16 hours later that I have a confirmed diagnosis and see the patient concious again. If I go home I do not learn as much as I should, and in a sense the trade-off becomes whether we should have well-rested residents or well-trained independent practitioners.

There is no doubt though, that abuse takes place. I once went 10 weeks continuously on call every other night. Several of those weeks bordered on 140 hours in the hospital. At the end of that period I literally had no idea of day or night. Fortunately, the safety issue is addressed by many laws against overworking residents, by providing us places to sleep while on call when we can, by senior attendings who are available to us for help at anytime, and by us looking out for each other. We are quite stringently supervised because the senior surgeons feel a great deal of responsibility for their patients also. Our failure can have grave repercussions for them personally. No one will allow a resident to do something unles s/he demonstrates competence beforehand. Finally, there are nurses, assistants, PA, and ancillary staff, who will all try to have the patients best interest in mind, providing a network of checks and balances of sorts. Patients in hospitals with residents have consistently better treatment outcomes. Although there are instances of failure on the part of hospital leadership and administration which overburdens residents, by and large residents are very well supervised and supported. Of course, one has to recognize when one needs help and ask for it. No one likes a cowboy.

However, because residency training is paid for by the federal government out of Medicaid, the resident tends to work a lot of hours. The government pays the hospital x-amount per resident (I believe it was around 75K a few years ago). The hospital pays me a fraction of it, and because of me they don't hire a PA for 80-90K a year. Thus every patient I saw on my measly salary made/saved the hospital money. Just the way it works.

Many residencies are moving away from the current model. In surgery, so many people were quitting or not considering the profession at all that something had to be done to improve work hours. And we were losing quality female applicants. Whether quality of care will stay high remains to be seen. I think it will remain the best in the world.
 
Do they have a medical residency in Europe?


Yes they do.


Do they work 80 hours per week?


Hell no!!!


Are they less competent doctors than in the USA?


I do not think so.



Why such difference?



G R E E D!!!


Only in america you can hire a medical doctor with 8 years of post-high school education to work for $7 per hour.

ONLY IN AMERICA!!!
 
Is the training system different in Europe?
Is it longer?
Is medicine socialized without market forces to warp residencies in the same way?
Do the Governments pay for a much larger portion of the training costs?
Are labor laws different?
Are there fewer physicians in a generally smaller medical market?
Is it a different tradition?
Are their interventional therapies far far behind ours and do you have to wait forever to receive them?

Greed/ profit concerns on the part of hospital administration do play a role in long resident hours, but it is not the only reason. Please have some more solid information and rationale before you post something so insulting.
 
Originally posted by DoctorDoom
Is the training system different in Europe?
Is it longer?
Is medicine socialized without market forces to warp residencies in the same way?
Do the Governments pay for a much larger portion of the training costs?
Are labor laws different?
Are there fewer physicians in a generally smaller medical market?
Is it a different tradition?
Are their interventional therapies far far behind ours and do you have to wait forever to receive them?

Greed/ profit concerns on the part of hospital administration do play a role in long resident hours, but it is not the only reason. Please have some more solid information and rationale before you post something so insulting.
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training in europe does suck. the residency lasts forever, and, at least in the CR, you do lots of in-house call, even as an attending. the residents i know are always around, they have lots of teaching and lecturing to do as well as patient care, and they NEVER complain. to me, it seems like i picture a residency in the 1960's or 70's. it's like st elsewhere!

but, from my experience here, the residents are abused at least as much as they are in the US. they never leave the hospital! i have profs that spend a couple nights a week in thier office, and nearly every prof has a bed in his office. so, don't look to all of europe for better hours...

also, i would say that interventional therapies are not that far behind, if at all. it is a pretty common misconception, but even here in the CR we have all the latest and greatest. don't know about the waits, etc, but if you give me some specific interventions i will be happy to check it out.

i don't really know enough, or have enough experience to chime in on the hours issue, but i thought i would clarify a bit about europe. it isn't all sunshine and roses as far as training is concerened, and we aren't nearly as far behind the times (except maybe in regards to the training programs...) as people seem to think.
 
5-O Prolene- I think you have a great perspective on graduate medical education, and I 100% agree with your sheep analogy. I am now at the end of 4-years of med school, and I have slowly realized that most of what doctors, particularly residents, do on a daily basis DOES NOT require a medical degree. Better/more support staff (ie. social workers, PAs, nurse practitioners) is the key to reducing all the garbage that residents perform on a daily basis; however, hospitals must pay these staff twice what they pay a resident, and they can't get 80 hours a week out of them without paying serious overtime. Residency is for learning, NOT for providing a cheap service to the hospital. Keep the good dialogue going. Crypt

M.D.= Massive Debt
 
Is the training system different in Europe?


Yes, it is (not a slavery). Doctors don't do phlebotomy at all. I am not sure if they know how to do that.


Is it longer?

No



Is medicine socialized without market forces to warp residencies in the same way?


What that has to do with overworking residents? Ah yes, money and cheap labor!


Do the Governments pay for a much larger portion of the training costs?

Goverment pays for everything...Even medical schools are FREE!!!



Are labor laws different?

Probably, since they do not get as much abuse as here in the states.


Are there fewer physicians in a generally smaller medical market?

Europe has about 700 million people while USA has about 260 million. Why would the USA have a larger market?



Is it a different tradition?

WHat do you mean? "The rite of passage" (and abuse) thing that everybody went through...."When I was a resident, we used to work 200 hours per week...bla, bla, bla...and nobody ever complained". Yeah right!



Are their interventional therapies far far behind ours and do you have to wait forever to receive them?


No!
 
The doors open....feel free to leave as soon as you'd like...

I'm sure the entire European medical community is waiting for you with wide-open arms.

Don't let the door hit you on the way out.
 
Rajvosa, you are revealing your lack of knowledge. My questions were rhetorical. Let's review:

Originally posted by rajvosa
Is the training system different in Europe?

Yes, it is (not a slavery). Doctors don't do phlebotomy at all. I am not sure if they know how to do that.

Aside from the question of whether not being able to draw blood is a good thing or not, the training in Europe is different for more reasons than because doctors don't do things that are unfairly referred to as "unnecessary garbage". And it is quite demanding and time intensive, based on the time I spent in the NHS is England. And did you even read Neilc's post?

Is it longer?

No

Actually it is. Basic medical education begins after high school or Gymnasium (Germany) or whatever, lasting 6 years, but the actual medical training lasts at least 2 years followed by 4-6 years or registrar level training. A minimum of 6 years. Then general practice training on-site of practice. So it is longer.

Is medicine socialized without market forces to warp residencies in the same way?

What that has to do with overworking residents? Ah yes, money and cheap labor!

It is not as simple as you make it out to be. And if you actually knew what you were talking about, you would know that European residents get worked only marginally if at all less, but patients get to sit in hospital for far longer. Such that if they are working fewer hours they are taking care of more patients, such that the general level of care drops. European residencies are warped in different ways to the same end, how does your simplified explanantion of American greed explain that?


Do the Governments pay for a much larger portion of the training costs?

Goverment pays for everything...Even medical schools are FREE!!!

Yes I know that. Governments also pay for health care. For their own socialized system. If you read my previous post you would know that I knew this, but again it is only one aspect of of the long hours that residents face. Yet despite the lack of monetary incentives residents work impossibly long hours with huge patient loads. Just like we do here. How does greed explain that?

Are labor laws different?

Probably, since they do not get as much abuse as here in the states.

Again, your ignorance and oversimplification shows. Labor laws were carefully negotiated in Europe, while the same did not occur here. But the idea they get less abuse is a false one. EU laws prohibit long work hours, but they do it anyways. And attendings (General practice trainees, another level of training, really) pick up the slack. The amount of in house call house officers and attendings take is tremendous.

Are there fewer physicians in a generally smaller medical market?

Europe has about 700 million people while USA has about 260 million. Why would the USA have a larger market?

This was a question to see how much you really knew and you walked right into the trap. Because medicine is socialized in the EU. Resources are rationed and physicians assigned to places. Private medicine is relatively uncommon. It is not a fully developed market like it is here. Fewer positions and medical care facilities per 100K in population. That's why physicians from Europe end up working all over the world. Many of my German friends complained about the limited number of positions available. The point is that the socialized approach eliminates monetary incentives and yet the residents still work forever. Again, how do you explain that?

Is it a different tradition?

WHat do you mean? "The rite of passage" (and abuse) thing that everybody went through...."When I was a resident, we used to work 200 hours per week...bla, bla, bla...and nobody ever complained". Yeah right!

I mean the fact their residency system developed quite similarly. American residencies are based on European ones. Rite of passage and apprenticeship is stronger in Europe than it is here. The fact is that tradition does play a role.

Are their interventional therapies far far behind ours and do you have to wait forever to receive them?

No!

Really? How do you explain me as a MS-3 teaching senior residents how to do lap choles? How long does and elective lap chole patient have to wait before getting a procedure? 3-6 months. This is a basic intervention, not even a truly advanced one.

In other words, you are way off. I agree that administration and hospital greed does play a role, but to say that that is the only reason is to be ridiculous. Europe is not the paragon of medical training, and socialized medicine makes things very different when residency training is seen as employment to be negotiated with union workers in mind and across several ational borders. Please have useful information, or even facts (gasp!) before making simplistic assertions. And if you really don't want to work that hard, why are you in medical school here?
 
Originally posted by Crypt Abscess
5-O Prolene- I think you have a great perspective on graduate medical education, and I 100% agree with your sheep analogy. I am now at the end of 4-years of med school, and I have slowly realized that most of what doctors, particularly residents, do on a daily basis DOES NOT require a medical degree. Better/more support staff (ie. social workers, PAs, nurse practitioners) is the key to reducing all the garbage that residents perform on a daily basis; however, hospitals must pay these staff twice what they pay a resident, and they can't get 80 hours a week out of them without paying serious overtime. Residency is for learning, NOT for providing a cheap service to the hospital. Keep the good dialogue going. Crypt

M.D.= Massive Debt
Click to expand...

I have to say I disagree with you guys in one specific way. Much of the crap can be trimmed away, but you'll find that even when that happens you still have way too much to do. I was in a hospital with PACS, great transport (never transported a single patient), was called to do blood draws only if it was emergent and the nurses had failed after several tries, but just the sheer number of procedures and the need to watch patients closely will make you run all day. I was lucky as hell, but don't think that there isn't enough real educationally valuable work out there, so don't be fooled into thinking that by removing the drudgery it will automatically lead to shorter hours.
 
So much energy devoted to the hours issue....

I wish the ACGME, AMSA and all the other hysterical med students out there would put more energy into pressuring residency programs to improve residents working conditions.

24h transport, 24h critical care transport, on-line films, 24h phlebotomy, case managers and social workers to assist with discharges, and no covering non-educational services would all make residents' long hours in the hospital more valuable.

I haven't heard of any programs being shut down for violating these rules, even though some of them exist.

MacGyver, I'll let you check with your sources at Hopkins to find out how many of these things we have. Hopkins isn't perfect, never said it was. I'm just saying it's not as bad as you all think.

Long hours taken to an extreme are bad, there's no doubt about it. But on the other end of the spectrum, it is disruptive to patient care and to education to pass patients on to a new person frequently. Some of the worst patient care situations I have ever seen were in the emergency room when a patient was passed through 3 or 4 people while they waited for a bed. Fortunately these cases are rare. It's not because EM doctors are bad, it's because they really aren't set up to do longitudinal care.

DoctorDoom is a voice of reason. Thank you for providing your perspective.

It would be very interesting if everyone posting on this thread first had to state their level of training. For example, I'm a 3rd year IM resident.

I have a feeling that the most of the people advocating 30h or less shifts are med students or pre-meds.
 
I thought that training for MD degree in Europe is, in addition to being free, 2 years shorter.

High school + 6 years of med school (no college), while in England it is 3 years shorter (5 years med school straight from high school).


Residents in Europe work 40-50 hours/week and deal mostly with medicine issues and rarely (almost never) with secretary/social work/phlebotomy tasks.


Another error in your argument: actually Germany has more doctors per 1,000 people than the USA. It also seems that people go to doctor 2x more in Italy and Germany than here in the states.

Germany's supply of physicians is high. Students who meet academic requirements have a constitutionally guaranteed right to study medicine. This fact, plus an excellent and inexpensive university system, has resulted in the country's educating physicians at a much higher per capita rate than the United States. Between 1970 and 1990, the number of physicians in the former West Germany more than doubled, and in 1991 the country had 3.2 physicians per 1,000 population, a higher ratio than most other members of the Organisation for Economic Co-operation and Development (OECD--see Glossary). (In 1990 the United States rate was 2.3 per 1,000.) With 11.5 physician visits per person per year in 1988, West Germans and Italians went to a doctor more frequently than other Europeans. (In 1989 the United States rate was 5.3 visits per person per year.) Even so, expenditures to physicians per capita amounted to less than half (US$193) of those in the United States (US$414).


http://countrystudies.us/germany/122.htm



After all, it looks that Germans can give you more by using twice less money the the USA. And all that without abusing residents.



France has evem more physicians per capita (3.3):

Healthcare Comparisons - France
Amount spent on health per person: US$2,102
Total health expenditure as a % of GDP: 9.4
Public expenditure on health as % of GDP: 7.3
Private expenditure on health as % of GDP: 2.1
Public: Private ratio: 77:23
Hospital beds per 1,000 population: 8.1
Practising physicians per 1,000 population: 3.3
Practising nurses per 1,000 population: 4.97
Life expectancy at birth in years: 75.02(M) 82.72(F)
Infant mortality (per 1,000 live births): 4.58
 
Rajvosa, you are wrong for several reasons. Firstly, your information on per capita physician numbers is outdated. Check the information for 2000. My argument was not based on physician per capita but on the number of positions available and the total number of facilities for resident training. Secondly you make the assumption that all physicians are equivalent. In any case in a discussion about resident work hours it is relevant to discuss inpatient volumes and not simply national per capita statistics. Certainly physician visits are higher in Europe due to socialized medicine, but how is this germane to resident work hours? These people are visiting clinics and seeing attendings, not being hospitalized.

Thirdly medical school is not residency, the time of medical school training is shorter but we are talking about residency. Your second hand info about the length of pre-graduate education is irrelevant. Fourthly, per visit cost was lower in Germany, but that actually weakens your argument, because if greed was the driving factor wouldn't abusing residents as cheap labor actually reduce overall cost in the US? It does not because of ancillary costs such as imaging studies. The reason European per visit costs are low results from preventive care in the outpatient setting and pharmaceutical savings. Your numbers do not address inpatient costs and servicess rendered, where the US tends to lose money and where it actually relates to resident life. Looks can be deceiving, especially if you are using internet information you have not studied carefully. We haven't even begun to talk about torts.

Finally, what is your source for European resident work hours? What direct experience or sources do you have? No resident in Europe I ever knew worked 40-50 hour weeks. You are using specious information as evidence. You are also not clear in your position. Whose greed exactly? I would like to know what stage of training you are in and what you think are reasonable work hours. Indeed, why do you intend to enter the medical profession in the US at all? Or do you just think certain things are beneath you as a doctor?

Thanks Linie for your compliment. I agree that work conditions are most important, and removing the sundry ancillary tasks and outright abuse is the key. I was a general surgery resident. Doing admission H&P's for the neurosurgery attendings and ortho attendings, when we weren't ever going to se the patient again, was ridiculous. There was always lots of room for improvement in medical education, and limiting hours is the wake up call for all program directors around the country that they have to focus on training residents, to cut out the abuses.
 
source...hmmm....
 
Originally posted by Linie
But on the other end of the spectrum, it is disruptive to patient care and to education to pass patients on to a new person frequently. Some of the worst patient care situations I have ever seen were in the emergency room when a patient was passed through 3 or 4 people while they waited for a bed.
Click to expand...


Thats a copout BS excuse. Yes, there are transition problems if you shorten the shifts. However, those can be dealt with via effective management, policy changes, schedule tweaking, etc. Lack of sleep can NOT be dealt in any other way than getting more sleep.

You are using a strawman excuse. Dealing with patient transitional care issues is MUCH easier to work around than dealing with the consequences of sleep-deprived residents.
 
well, in my part of europe, i have never even heard of a resident working 40-50 hours a week. they work far more. granted, it is in a small country that isn't even EU for another couple of months. but, as doctordoom points out, it is a training system with very strong roots in tradition...

also, the point about patients sitting in the hospital far longer is right on. many of the admits here are on patients with a much lower level of acuity than in the states. the wards are always full. heck, there is even a dermatology ward, and folks get admitted with psoraisis and acne. no, i am not kidding. and, these patients do need to be seen by residents, etc.

i do agree that in some countries such as germany, i have heard that the training is much more managable...i never heard the 40-50 hour thing, but the average is claimed to be under the 80 limit we have. again, i am a bit ignorant about the process in other european nations, but my experience in this one actually makes me glad that i am returning to the states (cross fingers) to do my residency.
 
Sorry but Eastern Europe and Western Europe are two different worlds...something like the US and Mexico. Cannot compare the two...
 
Originally posted by rajvosa
Sorry but Eastern Europe and Western Europe are two different worlds...something like the US and Mexico. Cannot compare the two...
Click to expand...

well, that is a bit outdated, my friend...starting in may, many eastern european countries will be included in the EU. so, while there are many significant differences between countries still, they are much closer to being equal than, say, the US and Mexico.

several years ago, there were huge differences. now, when i come to prague from the states, there are very few differences. the economy is going nuts, the rennovations are amazing, pay is going up, corruption is going down, etc...

in a few more years, there will be no difference at all.

anyhow, that is besides the point. you claimed that resident hours in EUROPE are better than the states...well, in some cases it may be true, in some western europe countries. but, not all. and, the fact is, that residency positions in the states are still looked upon by my classmates from all over europe as dreamy. they would love to know exactly how long a residency takes, etc...the only exception i have even heard of is in scandanavian countries. those guys have it pretty good up there, and they seem to know it.

each countries' training program has pluses and minuses, of which hours worked are simply a very small part of the picture. when you consider everything, i think the US is still a decent model of training, even with the long hours and the scut work. like everything, there is room for improvement, so people will always be tinkering with it...
 
Dealing with patient transitional care issues is MUCH easier to work around than dealing with the consequences of sleep-deprived residents.
Click to expand...
And your level of training is....?

I have been so tired my face hurt. I have been exasperated by the most simple request when I was at 40+ hours awake. I have burst into tears everyday for 2 weeks straight because I was so tired and worn down. I have experienced long hours. Have you, MacGyver?

I support some of what the ACGME is doing. But I also have enough experience to have seen and been involved in the care of patients taken care of by too many people, so I know the problems that can crop up even with the best-intentioned sign-outs. That is (just) one reason I think that shorter hours taken to an extreme is seriously flawed.
 
I am glad to say that is not true.

In fact, the Charles Drew school of medicine, which runs 18 residency programs, is currently beign censured for lack of support staff.

Residents regularly draw blood, transport patients to and from studies, get urine samples, in fact do anything that the overworked and largely imcompetant support staff doesn't do.

Unfortunately, this just means residents have to go out looking for new jobs if the school is shut down. Surgery and Radiology have already been canned. So, the incentive to be a whistleblower isn't there.

As for working greater than 80 hours, yes, we've all done it. We would be working far more if not for Libby Zion and Bell. Any time there is a shortcoming in any part of the hospital, the residents work more hours to overcome it.

No one else will. Nurses and support staff simply quit, or refuse to take on more work. We don't complain because we are told complaining is weak and counterproductive, and we are supposed to be superhuman doctors.
 
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