Do Residents Work Too Many Hours?

[tonyyounmd]

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Hi everyone,
I've written an article for CNN.com on the controversy of resident work hours. Things are ever-changing, but this is (and has always been) a big issue for residents. I'd love to get your feedback and thoughts, as med students who are soon going to have to deal with this.

http://www.cnn.com/2012/06/26/health/youn-doctors-fall-asleep/index.html?hpt=hp_c2

I hope it gets you thinking!

 

[Hour30]

Just realized you are a fellow author. I think you are in detroit area too right? I work at Ford. I liked the 80 hour work week limit, but nothing more. As a surgeon, I want to be a rockstar not work 9-5 every day.

 

[Hour30]

Nice job on the article! Just read it. I think the interns need over night call. Most of the calls at night are intern-level issues that can be dealt with by them. Why push this up the chain to senior residents who should be operating the next day? I hope they don't increase the restrictions too much more or it could compromise training. The main thing is to prevent mistakes, and we can do this by not letting people operate after hour 24 or 28.

 

[calvnandhobbs68]

Hi everyone,
I've written an article for CNN.com on the controversy of resident work hours. Things are ever-changing, but this is (and has always been) a big issue for residents. I'd love to get your feedback and thoughts, as med students who are soon going to have to deal with this.

http://www.cnn.com/2012/06/26/health/youn-doctors-fall-asleep/index.html?hpt=hp_c2

I hope it gets you thinking!

Not a comment right now on this article but I liked your article a couple months back about physician pay...and the guy who spent the $3,000 insurance check instead of reimbursing the plastic surgeon.

 

[link2swim06]

Hi everyone,
I've written an article for CNN.com on the controversy of resident work hours. Things are ever-changing, but this is (and has always been) a big issue for residents. I'd love to get your feedback and thoughts, as med students who are soon going to have to deal with this.

http://www.cnn.com/2012/06/26/health/youn-doctors-fall-asleep/index.html?hpt=hp_c2

I hope it gets you thinking!

Wouldn't the alternative to fewer hours mean residency would last more years?

 

[genswim24]

Wouldn't the alternative to fewer hours mean residency would last more years?

Just watched a lecture demonstrating that residents in surgical specialties average working the equivalent of 95 less work weeks during their 5 year training due to the 80 hour work week. That is a lot of training and logically would make a difference in competence for graduating residents. He also showed the large increase in board failure that has occurred with graduating seniors in his field since the hour restriction began. The failure rate increase has occurred in spite of higher board scores and grades from incoming residents.

With that in mind, his residency program is now six years. This is not an extra year of research, it is another year of surgical training. It sounded horrible to me and my fellow classmates, and none of us were interested in his program after hearing this. I think this is the wave of the future, I am just glad it shouldn't affect my training. I personally would rather add some hours per week than add another year. This doesn't mean the days of working 115 hours per week, but 95 still seems like a better alternative to another year of residency.

 

[ucladoc2b]

Have any studies ever shown a benefit from increased work hours, longer shift durations, and sleep depriviation?

Also, how does tacking on additional years of training produce better doctors? Residency for the previous generations used to be shorter. The acuity of in patients is much higher than it used to be and more technically challenging. Yet there is no requirement for skill refresher and training (other than some minimal CME) for board certified docs. Seems strange...

 

[tonyyounmd]

Congrats on your book Hour 30! I always love a good medical memoir.

 

[MsKrispyKreme]

I think 80 hr work weeks are sufficient but I also think residents need to be paid more...like double.

$80K/yr for working 80 hrs/wk seems fair. It's ridiculous that the nurses, social workers, etc. earn the same if not more than the residents especially in light of skyrocketing tuition debt.

I think far fewer residents would complain about the extension of residency by 1-2 yrs if they were properly compensated.

Nota bene: this is my post prior to reading your article.

 

[JackShephard MD]

Just watched a lecture demonstrating that residents in surgical specialties average working the equivalent of 95 less work weeks during their 5 year training due to the 80 hour work week. That is a lot of training and logically would make a difference in competence for graduating residents. He also showed the large increase in board failure that has occurred with graduating seniors in his field since the hour restriction began. The failure rate increase has occurred in spite of higher board scores and grades from incoming residents.

With that in mind, his residency program is now six years. This is not an extra year of research, it is another year of surgical training. It sounded horrible to me and my fellow classmates, and none of us were interested in his program after hearing this. I think this is the wave of the future, I am just glad it shouldn't affect my training. I personally would rather add some hours per week than add another year. This doesn't mean the days of working 115 hours per week, but 95 still seems like a better alternative to another year of residency.

I'm happy with 80. I'd like to do other things than medicine with my life.👍

 

[xanthomondo]

I think 80 hr work weeks are sufficient but I also think residents need to be paid more...like double.

$80K/yr for working 80 hrs/wk seems fair. It's ridiculous that the nurses, social workers, etc. earn the same if not more than the residents especially in light of skyrocketing tuition debt.

I think far fewer residents would complain about the extension of residency by 1-2 yrs if they were properly compensated.

Nota bene: this is my post prior to reading your article.

I agree with this. The nurses who work at the same place I do get paid double my salary for half the amount of hours that I put in.

The only problem is where is the money going to come from. Hospitals certainly won't fork the money over and the government is cash-strapped as it is.

 

[genswim24]

I'm happy with 80. I'd like to do other things than medicine with my life.👍

I mean I have no innate desire to work 95 hours a week, 80 is fine, 60 is even better. My only real opinion on this is that is that I don't want to lengthen the residency I am doing in terms of years. Not only is it a huge financial hit by losing a year of salary as staff, but it is also another year of loan interest accruing, and another year of pretty terrible hours. If they are going to try and add hours of training, I would rather get them over with during a shorter period of time. Plus the additional 150k plus I will be earning a year as staff will make doing other things outside of medicine more attainable (for me travel is my favorite hobby).

 

[JackShephard MD]

I mean I have no innate desire to work 95 hours a week, 80 is fine, 60 is even better. My only real opinion on this is that is that I don't want to lengthen the residency I am doing in terms of years. Not only is it a huge financial hit by losing a year of salary as staff, but it is also another year of loan interest accruing, and another year of pretty terrible hours. If they are going to try and add hours of training, I would rather get them over with during a shorter period of time. Plus the additional 150k plus I will be earning a year as staff will make doing other things outside of medicine more attainable (for me travel is my favorite hobby).

5 years is too long to give up important stuff. And not wanting to extend residency, everyone says that. But most people in surgery do fellowships adding 1 or 2 years. Once you let something consume your life for 6+ years, it becomes habit. After residency, you likely won't change your priorities. There will be a new practice with new demands keeping you from travel, working out, family, hobbies, etc. The demands increase, they don't end.

 

[SurfingDoctor]

Nowadays, they don't work enough. 16 hour work limits = multiple handoffs, less learning, no continuity (ie bad for residents and patients)

 

[ucladoc2b]

5 years is too long to give up important stuff. And not wanting to extend residency, everyone says that. But most people in surgery do fellowships adding 1 or 2 years. Once you let something consume your life for 6+ years, it becomes habit. After residency, you likely won't change your priorities. There will be a new practice with new demands keeping you from travel, working out, family, hobbies, etc. The demands increase, they don't end.

Agreed. And most of your learning curve will be done in the first couple of years (kind of same with any job/trade).

It's almost impossible to know everything about your specialty. Residents have to become attendings eventually. We can't keep people in training forever.

 

[ucladoc2b]

He also showed the large increase in board failure that has occurred with graduating seniors in his field since the hour restriction began. The failure rate increase has occurred in spite of higher board scores and grades from incoming residents.

Would this be due to the hours restriction? Or were there changes in board content/volume/difficulty that made the exam harder and increased the failure rate?

 

[KinasePro]

My problem with this article is that the types of people that browse CNN won't even read it in its entirety... they'll just see the headline and mentally store it away, later using it as obtuse rationalization for their hatred of doctors.

"Oh look, surgeons are falling asleep while doing surgery? Big surprise. As if they weren't already overpaid & corrupt, now they sleep on the job too."

 

[genswim24]

5 years is too long to give up important stuff. And not wanting to extend residency, everyone says that. But most people in surgery do fellowships adding 1 or 2 years. Once you let something consume your life for 6+ years, it becomes habit. After residency, you likely won't change your priorities. There will be a new practice with new demands keeping you from travel, working out, family, hobbies, etc. The demands increase, they don't end.

Yeah, I guess it's just a difference of opinions. I don't know any attending that work hours in the ballpark of what they did in residency. This may be the specific field that I am interested in, but for me it's a light at the end of the tunnel. There will always be demands, that is the nature of medicine. All of the guys I have worked with through three different programs have managed to have a balanced life and am confident I can do the same.

My life is already going to suck at 80 hours a week. It's not like that many hours is going to allow me to enjoy all of my outside activities as is. To me, I would rather just get residency over as fast as possible and move to the next phase of my life. Just a personal preference, and I can understand why others would feel differently.

 

[genswim24]

Would this be due to the hours restriction? Or were there changes in board content/volume/difficulty that made the exam harder and increased the failure rate?

Hard to say because it wasn't my presentation. He pretty much just showed a graph to the audience with the average pass rates for each year since the implementation of the 80 hour work week. There was a progressive decline that lined up pretty well with the restriction. Could there have been changes in the board content, sure. I really have no idea since it was his talk and the presentation itself was probably biased by his opinion. I am not definitely for/against 80 hour work week since there are good arguments both ways. I really just don't want to add years to my residency.

 

[tonyyounmd]

KinasePro, I agree with you concern regarding the headline of the article. Sometimes the headlines I write make it on the article, other times the CNN editor decides to change it up. This one is a headline-getter, which is good, but if a person doesn't actually read the article may conjure up the wrong idea.
Hatred of doctors is, unfortunately, too common nowadays.

 

[Buzz Me]

It's ridiculous that the nurses, social workers, etc. earn the same if not more than the residents especially in light of skyrocketing tuition debt.

Did you know some nurses (based on ICU/ER/acuity, night/weekend/holiday shift differentials, overtime, etc.) can make $100-140k a year?

 

[link2swim06]

Did you know some nurses (based on ICU/ER/acuity, night/weekend/holiday shift differentials, overtime, etc.) can make $100-140k a year?

And nurse anesthetist can even break 140K, I think there average is ~ the same as a family med attending physician. Not bad considering you can get it 2 years out of college.

 

[xanthomondo]

And nurse anesthetist can even break 140K, I think there average is ~ the same as a family med attending physician. Not bad considering you can get it 2 years out of college.

It's not that simple. But yeah I don't agree with the scope (and salary) nurse anesthestists have gotten themselves.

 

[link2swim06]

It's not that simple. But yeah I don't agree with the scope (and salary) nurse anesthestists have gotten themselves.

Pertaining to? I was referring to AAs for the educational length.