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if you want to be a surgeon, you also only do 80 hours right?
- Thread starter cheetoSnacks
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deleted109597
No, they petitioned Congress so they could have different rules.
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Ha ha ha. Sure, buddy. 80 hours. That's all. They guarantee it.
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Are we talking biweekly?😛
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Remember: The laws only apply to residents.
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so i know you're not in medicine and just asking out of curiosity, but if you were in medicine and considering a career in surgery, you'd quickly discover that 120 hours more then norm. law or no law. maybe there's a surgery program out there with lower hours, but if so, none of my med school classmates now interns are experiencing that. try "i haven't seen my wife in 3 days" and "i've only had 2 days off all month." surgery. no thanks.
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And they are only "law" in New York; otherwise they are guidelines which only apply to residents in ACGME residencies, not fellowships and not as attendings (even if most programs were compliant - JAMA and Committee of Interns and Residents survey found less than 50% of residents reported their programs were compliant).
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The "80 hours" rules saved surgery -- all of a sudden it became a competitive specialty again. Who cares if it's all a big lie, right? I would be highly impressed if there is a single resident in an academic program in the US who is compliant with these regulations. Everyone at the program where I went to med school blatantly cheated and lied about their hours.
Besides, patient safety is highly overrated anyway.
Besides, patient safety is highly overrated anyway.
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deleted109597
The only way to make programs actually have to follow the guidelines would be to allow you to report them anonymously. For some reason the ACGME thinks that they should know who tells, and of course tells your home institution when you rat them out. It makes it real hard to be a whistleblower.
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I always reported my hours accurately as an intern, but I wasn't categorical so they couldn't hold that over me.
If you lie, they will never know that the system is still broken.
If you lie, they will never know that the system is still broken.
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To the OP:
My experience only echoes what others have posted. I have yet to meet a resident surgeon who has been within the work hour rules.
Wook
My experience only echoes what others have posted. I have yet to meet a resident surgeon who has been within the work hour rules.
Wook
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If you don't like to work hard/long hours, then don't become a surgeon.
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They are pretty strict in New York City. I'm an intern at a surgery program in the city, and I've been reprimanded by my program director for being in the hospital too many hours. (!) There is a real incentive to get us out of the hospital, as they can face heavy fines. Although on some rotations it is impossible to finish your work in 80 hours, for the most part they are really trying.
I'm pretty sure this is just NYC.
But... if you are going into surgery you should WANT to work more than 80 hours a week. It has to be your life. 🙂
I'm pretty sure this is just NYC.
But... if you are going into surgery you should WANT to work more than 80 hours a week. It has to be your life. 🙂
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This shows why the Prelims are always under suspicion as being the whistle-blowers if a program is in violation of work hours and the ACGME knows about it. What do they have to lose if the program is put on probation (although many designated prelims may not realize that the department of surgery covers lots of the subspecialties and if gen surg is on probation, everyone is).😳
Chief residents who are graduating are also under suspicion...they figure they're leaving, so if they don't have any fond feelings or ties, doesn't matter to them either.
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Misterioso, it's not about how cool you are, it's a patient safety issue. My ability to make competent care decisions is considerably impaired past 20 straight hours of work, and I catch myself making small mistakes. And I'm in IM, not holding a scalpel over someone's aorta.
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I have to agree. It takes a lot of effort after 30 hours without sleep to really concentrate, especially on mundane things which are actually pretty important. It would be different if I could get a few hours of sleep overnight but this is rarely possible.
I don't think it's a macho thing at all. Everybody gets tired and everybody gets sloppy. I once went almost 40 hours on call without sleep and I was extremely dangerous to patients and myself. I took a nap in the call room before I went home (which turned into a six hour snooze) because I knew I'd wipe out on the drive.
You all can brag about how you don't need sleep but it's all a front. I'm sure different people have different levels of tolerance for sleep deprivation and maybe surgeons self-select for this trait but I suspect everybody acts like a drunk after missing sleep.
You're not a threat to patients if there is a crisis because then your adrenelin kicks in. You are a threat to patients through sloppiness and lack of attention to detail to the routine things (like ordering meds) that can sneak up and kill somebody.
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I spoke with a few residents and attendings at my med school and although some did not say they obeyed the 80 hour work week (as current residents), most did agree that the new work limit has made it much, much easier on the current batch of residents. So, I guess for that we have something to be thankful for.
Ditto on the whole 'what is so good about sleep-deprived surgeons' thing? I mean, what could you possibly learn and do well on when you have been without sleep for 30 hours straight? It's amazing to me to hear older doctors tell it like it's some exhiliarating thing to go for so long without sleep. People can't function with no sleep! It doesn't take an MD to realize that!!!
Sorry, it just annoys me that the idea of "training: is used right now as an excuse to extract slave wages off of residents who have no control over their work schedules.
Ditto on the whole 'what is so good about sleep-deprived surgeons' thing? I mean, what could you possibly learn and do well on when you have been without sleep for 30 hours straight? It's amazing to me to hear older doctors tell it like it's some exhiliarating thing to go for so long without sleep. People can't function with no sleep! It doesn't take an MD to realize that!!!
Sorry, it just annoys me that the idea of "training: is used right now as an excuse to extract slave wages off of residents who have no control over their work schedules.
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Who said anything about it being about how "cool you are"? The point is that surgery residents (attendings too) have always worked hard and long hours. It's a given that if you do surgery then you're going to get worked. Everyone knows this. So I find it funny how so many people feign that it's a "patient safety" issue when really they usually use that excuse because they don't want to work as hard as their predecessors did.
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Surgery residency should offer two tracks:
1) 7yr residency program where you work less than 80hrs a week
2) 5yr program where you work 100-120hrs a week.
I think option #2 will still be more popular.
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I don't know, I think people will switch to option #2 after the first year, especially when residents see their personal lives suffering.
Besides, I think it's ridculous to assume that a person learns more because they're in the hospital for 100 hours vs. 80 hours. There is a point of drastic diminishing returns when the human brain has no time to rest.
Smurfette
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For those of you who aren't residents yet, you may find your opinions change once you are in residency.
Do the work hour regulations affect learning? Absolutely. I have missed out on cases due to having to leave post-call. I would probably be more proficient and definitely have more logged cases and more experience seeing pathology, aberrant anatomy and operative techniques and repairs if hours weren't restricted. Have I been in the OR and been so tired I just wanted to leave?...well, yes. But normally I feel like I am going home wishing I could stay to see or do a certain thing, which is frustrating. I'm not saying I want to work an unlimited number of hours, but it's hard to leave knowing that you are missing an opportunity and don't know if or when another similar one will present itself to you again. I think that's where the surgery mentality comes in...we WANT to know how to do stuff and we are willing to do more hours in order to learn.
Now, sitting in lectures when post-call for me is essentially useless....I'll nod off because it's too passive. But frankly, in med school I would nod off regularly in class anyhow without being post-call....
Do the work hour regulations affect learning? Absolutely. I have missed out on cases due to having to leave post-call. I would probably be more proficient and definitely have more logged cases and more experience seeing pathology, aberrant anatomy and operative techniques and repairs if hours weren't restricted. Have I been in the OR and been so tired I just wanted to leave?...well, yes. But normally I feel like I am going home wishing I could stay to see or do a certain thing, which is frustrating. I'm not saying I want to work an unlimited number of hours, but it's hard to leave knowing that you are missing an opportunity and don't know if or when another similar one will present itself to you again. I think that's where the surgery mentality comes in...we WANT to know how to do stuff and we are willing to do more hours in order to learn.
Now, sitting in lectures when post-call for me is essentially useless....I'll nod off because it's too passive. But frankly, in med school I would nod off regularly in class anyhow without being post-call....
We do 2 months of night float as interns and 4 months as PGY3s. In return, there is night float during the weekdays, so you're never post call and missing a great afternoon case. Non-night float calls average q14 days, and are on the weekends. So, post call you go home way earlier than you would during the week and you're not missing any big cases.
I guess my point is, things aren't in black and white. Complying with 80 hours doesn't inherently force you to miss out on things, there's just plenty of programs that haven't adapted to the new rules in an efficient manner.
Not all programs force residents to work 120 hours/week, nor is it necessary for a strong surgical education. For a full rant, you can search my old posts.....
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Very good point SLUser. The issue, at least at my home program, was a massive cranorectal impaction (not unique to surgery in all fairness, a large number of "Top" IM programs got slapped for RRC violations too, likely for the same reason +/- thinking they were above the law).
In terms of missing cases, I suppose watching is fine (I'll attend noon conferences post-call if I think they are interesting, not counting it into my patient care time). But can anyone here honestly say they would feel comfortable being operated on by a sleep-deprived exhausted surgeon? Would you show up in the OR drunk (a well-documented equivalent of post-call sleep deprivation) and operate? Can I please have your name so I don't inadvertently become your patient?
As far as the "unwillingness to work as hard as predecessors," I want to see the complication rates of someone who routinely operates sleep-deprived versus a well-rested surgeon. Technically, you are in this to help, not to butcher people.
The beauty of work-hour rules is that they (at least in theory) force people to go home. This is important because medicine (all specialties) attracts pathologic workaholics who would rather be tired and miserable but at work, at the expense of their health, personal lives, and patient safety.
In terms of missing cases, I suppose watching is fine (I'll attend noon conferences post-call if I think they are interesting, not counting it into my patient care time). But can anyone here honestly say they would feel comfortable being operated on by a sleep-deprived exhausted surgeon? Would you show up in the OR drunk (a well-documented equivalent of post-call sleep deprivation) and operate? Can I please have your name so I don't inadvertently become your patient?
As far as the "unwillingness to work as hard as predecessors," I want to see the complication rates of someone who routinely operates sleep-deprived versus a well-rested surgeon. Technically, you are in this to help, not to butcher people.
The beauty of work-hour rules is that they (at least in theory) force people to go home. This is important because medicine (all specialties) attracts pathologic workaholics who would rather be tired and miserable but at work, at the expense of their health, personal lives, and patient safety.
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Wow, to be honest, I think even 80 hours a week sucks. Is that in 5 days? Kudos to you surgery types for giving up so much personal time.
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deleted109597
There's 7 days in my weeks.
Oh, you don't get weekends off. For the rest of your life.
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I was thinking the same thing. Who the hell else is gonna take care of your patients those other 2 days of the week?
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I think the unpopularity of Internal Medicine with American medical students might have something to do with the call and scut hell that many of these programs have become.
I'd hate to do Q4 call for three years. This is no way to live. And I wish they'd stop calling it "call" which implies that you are available to be called on the rare chance that you are needed.
It's not "call," it's "work." In two years I have only been able to sleep more than a few hours on call a handful of times.
I know that residents had it harder only a few years ago. On the other hand, forty years ago when hospitals moved at a slower pace you may have been at the hospital longer but you had a more stable census full of people for whom there were many, many fewer internventions and studies to keep track of.
The paperwork burden, something that must eat up at least half (if not more) of my time, was a lot less back then too. If you can't train a resident in any specialty in 80 hours a week then you need to look at cutting out some of the scut and clerical work that eats up so much of our time.
I'd hate to do Q4 call for three years. This is no way to live. And I wish they'd stop calling it "call" which implies that you are available to be called on the rare chance that you are needed.
It's not "call," it's "work." In two years I have only been able to sleep more than a few hours on call a handful of times.
I know that residents had it harder only a few years ago. On the other hand, forty years ago when hospitals moved at a slower pace you may have been at the hospital longer but you had a more stable census full of people for whom there were many, many fewer internventions and studies to keep track of.
The paperwork burden, something that must eat up at least half (if not more) of my time, was a lot less back then too. If you can't train a resident in any specialty in 80 hours a week then you need to look at cutting out some of the scut and clerical work that eats up so much of our time.
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I have to tell you though... prelims are known to be abused by general surgery... so i dont blame them either.. heh... But I know what you mean...
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Q4 call forever is a feature of surgery and pediatrics much more than internal medicine. Most IM programs are either call-light all three years or call-heavy intern year, easing up considerably after that.
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Did you just lump together the call experience of pediatrics and general surgery?
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some programs are pretty strict about 80hrs. two things about that:
1) if your program adheres to 80hrs, that will be one of the only times in your life you work only 80hrs/wk. so many staff (at least where I did medical school) work more than the residents. they may get there later in the morning, but they also leave later in the evening
2) your proficiency as a surgeon is not only how book smart you are, but obviously how skilled you are from a technical standpoint. less hrs/wk = less OR time = less experience. even though 90 % of programs get you plenty of OR time by the time it's all said and done, every chance to cut is a chance to learn. not all lap choles are just lap choles, etc...there is no time to learn like residency. while learning continues as an attending, you are protected and (more importantly) ALLOWED to make "learning errors" and not know all the answers.
This most certainly applies to all fields of medicine, but really stands out in surgery where skill set, hands on and numbers really count. I am all in favor of 80hr/wk for sanity, safety and social life. i think that we are finally starting to realize the importance of a good nights sleep and pt safety, resident satisfaction and information retention. but it is a trade-off. in the end, the residents that graduate this year from surgery will be the first (I think) to complete training under the new rules. ask them to compare their numbers to those a few years ahead of them. there is likely a fair difference.
as for me, i am EM, so I rarely work 80hr/wk unless I am on a surgical rotation (in which case I regularly go over). last week I worked 97 hours. it really wasn't that bad. but after several weeks, months, years it could get pretty damn old.
I thought a chance to cut was a chance to cure.
Regardless, the system is not so defined/cut and dry. Less hours doesn't necessitate less OR time.....that's just how it ends up for programs and residents who haven't changed to adapt to the new rules.
I would also argue that the 80 hour rule has a bigger impact on patient management skills than on operative skills........
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this has nothing to do with the topic at hand
but IbnSina, that has got to be the coolest avatar ever
If/when you retire, I'd like to file an official request to jack it from you 😀
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Psst.
This may be relevant to your interests.
This also had nothing to do with the topic at hand. Carry on.
I think this is a good example of where the medical profession gets overly solipsistic. The regs weren't put in to make residents lives easier - nobody other than residents cares if residents get crapped on every single day. The regs were put in because people don't want you operating on them or diagnosing them after you've been up for 30 hours. And count me in that "people" whenever I need health care.
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What about Kudos for the rest of us who are in pediatrics, internal medicine, ob/gyn, and other specialties who are also working long hours and giving up our personal time? I agree that surgeons have it rougher than the rest of us but none of us have it cushy.
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njbmd
Let's see, when I was an intern in surgery (before the 80-hour work week), on pediatric surgery, I was on call 48 hours straight and off for 12, the peds intern was on call 24 hours and off for 48. Dramatically different call schedule don't you think?
After the work hours regs went into place, the hours are better. Are they perfect? No, but I do get more time at home and less time in the hospital. When I am in the hospital, I am busier but I do spend less time there. Some weeks, I am under 80 hours and some weeks I have gone over. In the end, I average around 80. Still, it's better than 120 and I try to get my junior residents home and under 80 hours. That's part of my duties as chief.
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The long hours are all about making you used to the demands so that you will be a better doctor. It teaches you a mentality that will help you be a better partner/doctor. Say you had to stay 4-5hours late, or got a call for an emergency at 3am? Who would make a big deal about cutting into "their time"? Someone who went through a residency were 100+hrs was not uncommon or someone who had an easy residency of 40hrs/week. It's about building expectations of becoming a better doctor so you get the job done, even if it goes beyond the time when your day was supposed to be over
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deleted109597
Riiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiight. Long hours are for cheap labor. And since more mistakes are made when you are without sleep, you shouldn't be doing it as an attending either. Unfortunately, the attitudes towards medicine are unlikely to change anytime soon.
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Absolutely. There are few of us who would even think of dropping everything and going home exactly on quitting time. If I'm doing something or need to follow up on something important I will stay as long as necesary without complaint and even feel a little professional pride that I sacrificed some of my free time for my patient.
But it just ain't like that most of the time. A lot of your time is going to be wasted doing totally useless clerical tasks that are only done, and see if you can spot the irony here, because they have residents who will do it.
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You cannot fight your physiology. I don't care how hardcore you are, you cannot make your brain function well without sleep, just like you cannot control your Purkinje fibers or your peristalsis.
The "better doctor" excuse is bull. Every honest respectable attending I know admits that being a resident under the old system a) sucked and b) was dangerous. And this is coming from people who trained in an era when everyone and their mom were hospitalized for any reason. The typical admission nowadays is hugely sicker than way back when.
The "better doctor" excuse is bull. Every honest respectable attending I know admits that being a resident under the old system a) sucked and b) was dangerous. And this is coming from people who trained in an era when everyone and their mom were hospitalized for any reason. The typical admission nowadays is hugely sicker than way back when.
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That is really my pet-peeve. Many of the old school attendings have admitted to me that in their day, back when technological medicine was in its infancy, a hospital stay was so inexpensive that their census could be mostly rock-steady nursing-home patients or essentially "cured" healthy people who back then stayed in the hospital a ridiculously long time not doing much of anything at all. Really sick people with multiple co-morbidities died at home because there was nothing to be done, unlike today where you can get a constant stream of people who all have CAD, PVD, CHF, COPD, IDDM, CABG, BKA, ILD, RA, and a few other nasty abbreviations in one package (I need to get a stamp) all showing up between midnight and five AM.
I'm talking people who fifty years ago would have been dead ten years before they could even hope to accumulate so many initials and if they did, when they got the symptoms that today brings them for an extensive stay in the ICU would have back then got a call to their priest for last rites.
When my grandmother was a girl, if you had heart failure and you got an acute onset of shortness of breath it was usually the end.
So, do I whine? Yes. Does my mangina cramp every now and then? Of course. Did the residents in the eighties and nineties have it tough? yes.
But it wasn't always so bad.
Way back in 2002?
I really like the 80 hour rule, but I believe it is much more beneficial to the resident than it is to the patient. Most literature I've read has shown no significant difference in patient care between pre-80 hour and post-80 hour times.
I have to include several disclaimers:
1. Most studies I've read have been surgical, where there's a bigger concentration of tough guys.
2. There is an inherent bias when the physicians conducting the research resent the work hour restrictions.
3. You can only really conduct retrospective studies......
I'll try to find links to some articles and post them.....
Panda Bear,
that mangina cramp... can't stop laughing... busted a gut...
*whew* gotta catch my breath...
let me remind the surgeons out there that the founding father of the American surgical residency, William S. Halsted, was a cocaine addict. does anyone not find insanity in prepetuating the legacy of someone who required COCAINE to keep his work hours?
that mangina cramp... can't stop laughing... busted a gut...
*whew* gotta catch my breath...
let me remind the surgeons out there that the founding father of the American surgical residency, William S. Halsted, was a cocaine addict. does anyone not find insanity in prepetuating the legacy of someone who required COCAINE to keep his work hours?
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You know, I reject the premise that we need to limit work hours to protect the patients. Maybe limiting the hours protects patients and maybe it doesn't. There is certainly a lot more potential for "handoff errors" today as opposed to in the old days simply because there is more handing off.
But the issue to me is that we all need to sleep. Depriving prisoners of sleep is deemed cruel and unusual punishment. Hell, even in Marine Corps boot camp they never interfered with our sleep and I got a solid eight every night. (And I mean solid. I was out before the lights went out and probably didn't stir until revellie.) During combat operations and training going without sleep is unavoidable but necessary so we operated and trained accordingly.
There is no similar need in medical training. We are not closing with and destroying the enemy. We go without sleep because our labor is so economical that it would be foolish for your hospital not to try to take as much advantage of you as they can.
