Is it reasonable to have residents and trainees including fellows, provide anesthesia for elective cases? Multiple providers providing anesthesia... doesn't seem rational. Sure these patients may be "asymptomatic" but perhaps they are carriers. Should we pursue a class-action lawsuit or something like that? Joked around about suing my department/hospital administration for endangering us but all around the country this is still happening - elective cases. Don't think residents get paid enough for this. Don't have "enough PPE" and only use it for "suspected cases". We're not testing everyone and still doing elective cases. If I suspect everyone is carrying it, shouldn't I be wearing a N95 mask at work? People are scared to come to work by the departments and hospital administration just wants to continue to make money. As trainees, I think it's hard for us to just walk away from the job because we we feel we need to be there. Does anyone else feel the same way? We're being put in unsafe conditions and it's not about the "training" anymore but just staffing and getting cases done. Should we all just sue our programs or the ACGME?
doing elective cases during Covid-19 crisis as a trainee
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Anyone extraneous - that is to be clear, students and non-essential personnel - should be sidelined mostly in an attempt to save our limited supplies (why have a medical student scrub in as the 8th assist for a lap chole?).
That being said, you are absolutely essential as an anesthesia resident. You are providing DIRECT patient care and do work that can’t be replicated by a single physician (as you are being covered 2:1). This is how it goes in training - you are there during disasters, it’s what you signed up for. You’re a physician now - step up and be a leader, which includes setting a strong example.
Don’t like it? Request leave. But certainly don’t expect a warm welcome back after all of this when you’re friends were busting their butts while you sat at home.
That being said, you are absolutely essential as an anesthesia resident. You are providing DIRECT patient care and do work that can’t be replicated by a single physician (as you are being covered 2:1). This is how it goes in training - you are there during disasters, it’s what you signed up for. You’re a physician now - step up and be a leader, which includes setting a strong example.
Don’t like it? Request leave. But certainly don’t expect a warm welcome back after all of this when you’re friends were busting their butts while you sat at home.
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I didn’t get the sense that the OP was asking to sit at home and watch Netflix. I did get the sense that he/she was questioning his hospital and department’s leadership in deciding to continue to do elective cases while telling staff they don’t have enough PPE. That seems like a reasonable question to me.
Many areas...especially urban areas where training programs tend to be concentrated...should be treating every intubation as if the patient is infected at this point. Doing otherwise would be irresponsible in light of the lack of availability of broad testing. If a hospital cannot provide the protective equipment needed then should we continue to put ourselves and potentially our families in danger?
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Unless you're always 1:1 with an attending there's no argument for your presence being extraneous or unnecessary. And even if you are at a 1:1 program, what's the alternative - sit around and nothing for months. Is that what you want out of training? An extension because you didn't do anything and didn't learn anything for an extended period?
You're not a student. You're a doctor and you're valuable, even if residents aren't always treated like assets. Go to work and be useful. Wear your PPE when appropriate. Take this opportunity to break the trainee habit of putting your face four inches from the patient during laryngoscopy.
Contemplating suing your program or the hospital is ridiculously inappropriate. It's also a guarantee that you'll burn bridges that will affect the rest of your career. People who flake during hard times are remembered.
You're not a student. You're a doctor and you're valuable, even if residents aren't always treated like assets. Go to work and be useful. Wear your PPE when appropriate. Take this opportunity to break the trainee habit of putting your face four inches from the patient during laryngoscopy.
Contemplating suing your program or the hospital is ridiculously inappropriate. It's also a guarantee that you'll burn bridges that will affect the rest of your career. People who flake during hard times are remembered.
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I hope I never have to work with you.
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Sue? To stop your training? If you don’t have enough equipment, go to your department and have them provide it. They should stop elective cases, if you don’t have enough equipment already.
What’s the price tag that you think residents should get paid to do this? Is there one? How about your older attendings?
This is what sick people look like, unfortunately.
Protect yourself the best you can, but this is invaluable experience. I am sure if a few years, this is where your best war stories come from.
Good luck.
Cosmetic procedures. 1:1 coverage with attending. Going from patient to patient. Spreading potential exposure.
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deleted171991
You should post the name of the hospital on social/mass media, and let it spread. Nothing works as well as bad PR.
On the other hand, the risks for a 30 year-old resident are smaller by a degree of magnitude than for a 45-60 year-old attending, somewhere around 1% (or less) risk of death.
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Ugh, nobody should be doing elective cosmetic work now. Your hospital is wrong, your anesthesia department is weak or greedy (or both) to go along with it.
I understand if you don't want to ID the hospital for fear of retribution. You don't have a lot of good options here.
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Ugh, nobody should be doing elective cosmetic work now. Your hospital is wrong, your anesthesia department is weak or greedy (or both) to go along with it.
I understand if you don't want to ID the hospital for fear of retribution. You don't have a lot of good options here.
Call the local news anonymously. Throw in the plastic surgeons name. That’ll get it stop soon.....
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Send an anonymous tip to local news. Show email communication from hospital leadership talking about the short supply of PPE. Do it anonymously if you fear retribution.
Not only is PPE in short supply, but you have to think of yourself as a limited resource. Having productive healthcare workers get sick is not good for anyone. There needs to be a push for hospitals to prepare for surges now by protecting limited resources...including yourself. Protecting yourself is not only about selfish self preservation, but also allowing yourself to be available to help others when needed.
Not only is PPE in short supply, but you have to think of yourself as a limited resource. Having productive healthcare workers get sick is not good for anyone. There needs to be a push for hospitals to prepare for surges now by protecting limited resources...including yourself. Protecting yourself is not only about selfish self preservation, but also allowing yourself to be available to help others when needed.
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What’s up with the initial responses chewing out this resident? Are you guys that are chewing out OP aware of what’s happening on a global scale (PAN-demic)? Y’all either misinterpreted what was said by OP or are beat into submission by the hospitals.
Residents and Attending physicians are just fodder for profits while these admins are “working” from home. Surgeons are trying to bang out as many cases now to prepare for the worst. How can a surgeon be trusted to decide which elective cases should continue? Conflict of interest doesn’t exist now? Good thing patients are canceling cases at our hospital. The same hospital system that was requiring us to stay in the state, ideally not even leave the city our hospital is in, 3 weeks ago for upcoming vacations, is now the same hospital that is “continuing with elective cases” as of this week. WTF. All while increasing traffic into hospitals with the population both most likely to be a asymptomatic carriers and be same day cases that go home. Why not just risk aerosolizing dozens of random people to several hospital staff and other patients? Elective ca$e$ > science. ***k em
Residents and Attending physicians are just fodder for profits while these admins are “working” from home. Surgeons are trying to bang out as many cases now to prepare for the worst. How can a surgeon be trusted to decide which elective cases should continue? Conflict of interest doesn’t exist now? Good thing patients are canceling cases at our hospital. The same hospital system that was requiring us to stay in the state, ideally not even leave the city our hospital is in, 3 weeks ago for upcoming vacations, is now the same hospital that is “continuing with elective cases” as of this week. WTF. All while increasing traffic into hospitals with the population both most likely to be a asymptomatic carriers and be same day cases that go home. Why not just risk aerosolizing dozens of random people to several hospital staff and other patients? Elective ca$e$ > science. ***k em
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deleted171991
One can certainly "***k em", as you say, but one should expect them to ***k one and one's career 10 times back.
There is a reason we say that anesthesia is a small world.
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deleted171991
Welcome to the new world of medicine, where all of us are Big Health's little
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I think your initial problem was going to a program that has 1:1 coverage for cosmetic procedures...
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You are at a minimum 9 months into CA1, right? How are you 1:1 on plastics cases? I would be asking for my money back on that training...
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I don't understand the question. Supervision ratio has nothing to do with case selection available, and 1:1 doesn't mean the attending has to be hovering an inch over the resident's shoulder micromanaging the IV drip rate all day.
OP isn't in my program. I don't know why he was assigned to this case or what the alternatives were. Maybe almost everything has been cancelled and this is what was left. Maybe this "cosmetic case" is a nose job in the middle of a 12-banger day of ENT. Regardless, there's value in learning how to do simple cases efficiently and well. You can't do face transplants every day.
What's concerning isn't that a resident has to slum it for some stupid cosmetic case, it's that elective cases are being done at all in this environment. The OP also stated a concern about PPE but it's hard to tell if he's being unreasonable or not from the information given.
