Filled surgery spots 2003 vs Unfilled in 2002

[IMSurg]

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I am curious why there was a ton of unfilled spots in surgery in 2002 and very very few in 2003?

 

[Azygous]

Could be the new 80 hour work week.
Could be a greater interest in surgery.
Could be that the "availability" of spots made more people apply thinking they would get better spots (which they probably did).
Most probably a combination of the above.

 

[droliver]

Actually, I've been told by a member of the RRC that the difference (at least last year) was made up of IMG/FMG applicants being accepted in higher levels then prior. There are however, a number of indices that do point to a larger applicant pool in the next few years when students are surveyed as more US grads appear to be planning on surgical careers. For all the problems I have with the 80 hr work rule, you have to assume more applicants is the direct result of it

 

[Foxxy Cleopatra]

I agree that a large reason that the applicant pool is climbing is a result of the 80 hour rule. It was a huge topic at about every interview I attended (I never brought it up, but PD's and chairmen often did.) Being in my second month of surgical residency and having rotated through 2 drastically different services, I have mixed feelings about the regulations and how/if they will be enforced.

There are real-life situations that make compliance very difficult. For example, I'm on transplant, and this week we got a local donor who happened to match for a liver, pancreas, and kidneys on 2 different people on the local waiting list so the surgeons needed to be in the hospital for well over 24 hours straight. The harvest and both of the subsequent transplants (one a liver + kidney, the other a panc + kidney) which we did back-to-back are very extensive operations. Plus, organs have a limited ischemic (out of the body) time so you can't postpone or schedule the operations at a later time.

On the other hand, while I feel that you need to be around for more than what the new laws allow to comply to be able to complete an experience like the one above, there are some inefficiencies in the system that make you feel like you waste many hours a week in the hospital that are not necessary. Sometimes, team communication is poor and inefficient. These are things that I wish would improve because to be honest, I'd rather have those hours to spend on doing things outside of the hospital.

I think that if the 80-hour workweek is a huge part of your decision to enter surgery to be cautious- I honestly do not see it being enforced in some places and don't know how it will ever be on some services. If you love surgery enough that you would do it regardless of the hours, you will be happy with your choice.

 

[Winged Scapula]

My impression is that it is a combination of all the factors listed above plus PDs "running scared", ie, fearful of the death knell that was being tolled for general surgery and perhaps looking more thoroughly at candidates they wouldn't have a few years ago (ie, IMGs/FMGs).

 

[apma77]

The people who chose surgery because of the 80 hr rule are likely to get weeded out during residency. This is because even with the 80 hr rule many places are non compliant and "fudging" the hrs for the rrc visit. also less hours doesnt mean that malignancy goes away. the arrogance and crass attitude in surgery still exists and for most "nice" people this is not the way to go.

so dont choose surgery based on the less hes now choose it cause u are willing to be a part of the club and willing to lose your lifestyle over it.

 

[UI2003]

Originally posted by apma77
so dont choose surgery based on the less hes now choose it cause u are willing to be a part of the club and willing to lose your lifestyle over it.

Then again, if you're a social misfit/sci-fi nerd like myself and have *no* lifestyle to lose, come on down! Seriously though, I actually like being the first doc "on the scene" as it were. During med school, I hardly got to work-up a patient from scratch so it was difficult to play the "what's the differential?" game. On the other hand, my program is getting around the whole 80 hr thing by switching a lot of rotations to home-call...meaning you get to go home and be woken up all night with nurse calls vs. staying in house for the same thing. Oh, and that time doesn't count against the 80hrs...sneaky sneaky....😛

 

[ckent]

Originally posted by UI2003
Then again, if you're a social misfit/sci-fi nerd like myself and have *no* lifestyle to lose, come on down! Seriously though, I actually like being the first doc "on the scene" as it were. During med school, I hardly got to work-up a patient from scratch so it was difficult to play the "what's the differential?" game. On the other hand, my program is getting around the whole 80 hr thing by switching a lot of rotations to home-call...meaning you get to go home and be woken up all night with nurse calls vs. staying in house for the same thing. Oh, and that time doesn't count against the 80hrs...sneaky sneaky....😛

Not only is that sneaky, that sounds dangerous to you all from a medico-legal standpoint. One of the things that was emphasized to us during my sub-i is to always lay eyes on the patient when you are called about a critical issue. If you get sued, saying that "the nurse told me that he was fine" isn't a good legal defense. Especially since nurses will lie to cover their butts as well and are poor documentors. The more likely situation will be that the nurse will claim that she/he asked you to see the patient, but you didn't feel like getting up from bed and driving in; while you will argue that the nurse didn't make it seem that important. The best legal defense is saying "I saw and assessed the patient, wrote a note in the chart, and he was stable when I left. Nobody called me about what happened later".

 

[dr.evil]

Not only is that sneaky, that sounds dangerous to you all from a medico-legal standpoint. One of the things that was emphasized to us during my sub-i is to always lay eyes on the patient when you are called about a critical issue. If you get sued, saying that "the nurse told me that he was fine" isn't a good legal defense. Especially since nurses will lie to cover their butts as well and are poor documentors. The more likely situation will be that the nurse will claim that she/he asked you to see the patient, but you didn't feel like getting up from bed and driving in; while you will argue that the nurse didn't make it seem that important. The best legal defense is saying "I saw and assessed the patient, wrote a note in the chart, and he was stable when I left. Nobody called me about what happened later".

How my program get's by with this is that we always have at least one person in house who can go lay eyes on a critical person if need be. This way, I take all the routine calls from home every night but if something were critical and needed to be addressed with a physician at bedside, that would be available.

This is how the real world is. You're a surgeon out in practice and get called at home for everything. You need to learn how to manage that as a resident so it won't be a shock when you're in the "real world". It also provides for excellent continuity of care as you know exactly what is going on with your patient at all times. MUCH better than checking out (for the patient at least).

 

[UI2003]

You don't have to go in at 2am to renew an order for pain meds. Nor do you have to see a patient to field a call from pharmacy to clarify an order at midnight. Another call might be: Nurse - "I see here you wrote an order for a Fleets enema, are you sure you want to give that?" Tired intern - "Yes."

These are the types of calls I get. Of course if I get a call about a patient in the ER or anything else *critical*, I go in. Clearer?

 

[droliver]

Call me an old school crank, but having very junior residents trying to sort out what is & is not an emergency over the phone is going to get someone killed. You just don't know enough or have seen enough at that point to triage some of that stuff over the phone. Several times a year I remember seeing devastating complications as people tried to manage things over the phone (and some of these were with the resident in house). The temptation to do that is even greater when you're home.

There are some guidelines loosely spelled out in the new work-hour for home call & the intent of these is that you should not be getting frequent pages or the hours should be counted towards the 80hrs. Your PD's should be having you keep some kind of log to get an idea of what most nights are like if they are truly interested in compliance

 

[dr.evil]

Call me an old school crank, but having very junior residents trying to sort out what is & is not an emergency over the phone is going to get someone killed.

I'll just have to call you an old school crank then.😛

Although in the first 6 months of residency I agree that delineating importance over the phone is somewhat tenuous, overall I think this can be readily done by most physicians. I'm not quite sure what the difference is in the nurse calling the resident at home and saying "the pt.'s BP is 70/40, p 130, and o2 sats 80% on nonrebreather" and the resident saying, "I'll have someone come by and look at him" vs the nurse call the resident who is in house and doing the same thing.

The threshold for 1st and 2nd year residents to call the in house resident is very low (as it should be). This provides for safe, efficient care.

I do see the risk if you didn't have an in house resident to call. With this scenario, the resident at home could potentially try to push things off until morning when he/she arrived for rounds.

Sadly, I've seen attendings do this very thing. Nurse calls, tells the a pt. is crumping, and they give some temporizing order and see the pt. 2 hours later at rounds. Not good care.

As for the call at home regulations, they are so loosely spelled out that they will be abused. My hours are still 100% better now than 1 year ago.