"Let First-Year Residents Work Longer Shifts, ACGME Proposes"

[CTFellowMD]

How do non-academic hospitals select patients? I thought hospitals were required to treat any patient who comes to the ED regardless of insurance.

Only for life or limb threatening emergencies. Once the patient is stabilized, they can kick them out. Transfers of underinsured patients from private to academic because they are "too sick" happens all the time. Also, EMTALA violations happen routinely in some private hospitals.

The big money is in elective procedures, though. Here there is definitely a lot of cherry picking going on.

What ProfMD said. We have a major academic center here (has plenty of midlevel support, but still completely dependent on residents) and also several private suburban hospitals that are affiliated with us (residents will rotate there in small doses, but for most part they are run by the midlevels). The smaller hospitals routinely cherry pick OR cases and ER patients. Anything overly complex gets shipped over to academic center. Community hospitals also don't have nearly the same education and research infrastructure to support the residents and save significant money on all the administrative assistants, coordinators, and what not they don't have to hire.

---

Members don't see this ad.

 

[chipwhitley]

What ProfMD said. We have a major academic center here (has plenty of midlevel support, but still completely dependent on residents) and also several private suburban hospitals that are affiliated with us (residents will rotate there in small doses, but for most part they are run by the midlevels). The smaller hospitals routinely cherry pick OR cases and ER patients. Anything overly complex gets shipped over to academic center. Community hospitals also don't have nearly the same education and research infrastructure to support the residents and save significant money on all the administrative assistants, coordinators, and what not they don't have to hire.

Well I guess I got screwed from both sides, because my program is a public community hospital that has very little education and research infrastructure (none), but at the same time doesn't have the money to hire midlevels. And they don't cherry pick patients, >50% are underinsured/uninsured, and they don't ship patients out anywhere because no one else will take them.

 

[meister]

It's funny watching everyone argue over working more hours for the same pay when you have "mid"-levels, some of whom are granted full practice rights, with an obnoxiously small amount of clinical training. Seems like rearranging the deck chairs on the Titanic.

This is partly a government created problem because they refuse to reimburse hospitals and physicians what they're actually worth, and in fact are aggressive in figuring out ways to pay everyone less. Well, everyone except chiropractors.

 

[DetectiveAlonzo]

Do it.

Pay us more though.

If not, oh well, I'll shut up and still do the work because that 6-fig check will be comin' three years later.

 

[NotAProgDirector]

My plan is to leave much of my program unchanged. I think 24 hour shifts are bad, mainly from a resident health point of view. But it is true that 16 hour max shifts has created a system where all interns get one day off per week. IM allows averaging, but the way the schedule works out it's simply easier to give everyone one day off per week -- which might be a Friday. Having 24 hour shifts on weekends would likely allow more weekend days off. This is going to be a controversial conv in my program, as I expect some interns will feel strongly both ways, and both are "right" to some extent.

 

[Jc2008]

Any thoughts?

http://www.medscape.com/viewarticle/871432

"First-year residents would no longer be limited to 16-hour shifts during the 2017-2018 academic year under a controversial proposal released today by the Accreditation Council for Graduate Medical Education (ACGME).

Instead, individual residency programs could assign first-year trainees to shifts as long as 28 hours, the current limit for all other residents. The 28-hour maximum includes 4 transitional hours that's designed in part to help residents manage patient-care handoffs.

The plan to revise training requirements does not change other rules designed to protect all residents from overwork. The maximum number of hours that they can log each week remains at 80. All residents must have at least 1 day in 7 free from both clinical experience and education. And in-house call can't be more than every third night. All these limits are based on 4-week averages.

The ACGME capped the shifts of first-year residents at 16 hours in 2011 as a part of an ongoing effort to make trainee schedules more humane and avoid clinical errors caused by sleep deprivation. Some medical educators and medical societies claim, however, that this particular reform has worsened the learning experience of first-year residents as well as continuity of patient care.

ACGME CEO Thomas Nasca, MD, told Medscape Medical News that the problem arises largely from first-year residents not being on the same schedule as supervising residents and others on their "home" educational team. On a 16-hour clock, first-year residents can end up working under relative strangers, said Dr Nasca. "The lack of synchronization is very disruptive."

The solution, he said, is putting everyone on the same clock.

And it's a safe solution for residents and patients alike, according to the ACGME. The group touts a study published in the New England Journal of Medicine in February showing that longer shifts and less rest in between for surgical residents did not affect the rate of serious complications or surgical fatalities. Residents working longer shifts were no more dissatisfied with their overall well-being than those whose shifts were capped in accordance with AGME standards. They indicated that their educational experience improved, but at the expense of personal time. The study, called Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST), encompassed 117 general surgery residency programs in 151 hospitals.

"A Dangerous Step Backward"

Not everyone buys these findings and the arguments for relaxing the 16-hour rule for first-year residents. Both the American Medical Student Association and the Committee of Interns and Residents, a union representing 14,000 physicians, oppose the AGCME proposal. The consumer watchdog group Public Citizen calls it "a dangerous step backward."

"Study after study shows that sleep-deprived residents are a danger to themselves, their patients, and the public," said Michael Carome, MD, director of Public Citizen's Health Research Group, in a news release. "It's disheartening to see the ACGME cave to pressure from organized medicine and let their misguided wishes trump public health."

Public Citizen says it has public opinion on its side. A recent poll commissioned by the group showed that 86% of Americans oppose lifting the 16-hour cap on the shifts of rookie residents.

Public Citizen also looks askance at the FIRST trial, funded in part by the ACGME. It accuses the study of neglecting to obtain informed consent from trainees and patients. To Dr Carome, the study conveniently arrived at the conclusions that its authors set out to reach.

For his part, Dr Nasca said the ACGME made a good-faith effort to arrive at a consensus decision by listening to specialty societies, certifying boards, patient safety organizations, and residents. And rather than ignoring the well-being of first-year trainees, he said, the plan would step up efforts to prevent burnout and depression. It calls on residency programs, for example, to ensure that trainees can make appointments with a physician or a mental health professional, even during their working hours. And faculty and residents must be trained to identify symptoms of burnout, depression, and substance abuse.

The ACGME proposal will go to the group's board of directors for a final decision after a 45-day comment period. More information on the proposal is available for download from the ACGME."

This is what happens in a system where employees (residents) have little to no rights, just like employees everywhere in the US. Look at rules governing residencies in other developed countries with similar physician salaries and medical outcomes. There are NO developed countries where working people like this is legal. It is not necessary, not humane, not smart and all excuses and explanations of why it is necessary are BS. When people regain control of their own self interest and stop voting the self interest of organizations and businesses (e.g. hospitals), then there will be a chance that this nonsense goes away for good. Germany- cannot work more than 48 hours per week in any job. UK- cannot work more than 48 hours per week unless you agree to waive this protection and you cannot be asked to waive it, it must be self initiated. Netherlands, 40 hours.

Also, the study they are using to support this change only involved surgery residents. Surgery self selects for some of the most workaholic people out there, who would not know what to do with their free time if they had it. Saying that, somehow, this finding must extend to every other specialty makes no sense. If surgeons and their cronies want to work 28 hour shifts, let them do it. Just don't impose this non-sense on the rest of the saner specialties. Not everyone takes pleasure in cutting people open and not everyone takes pleasure in having no personal life. As a side note, surgery is the specialty with the most self identified conservatives (together with anesthesiology, radiology and pathology) in all of medicine. Work work work puritans, pull yourself up by your shoe laces. Does it really surprise any one that people self selecting for this workaholic speciality would drive the re-workaholization of medicine?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1829428/

I don't think it's a stretch to equate this change to larger societal and political attitudes. And those who agree, must vote their opinion to end this charade.

 

[Jlaw]

28 hour shifts are literally ******ed. I don't care if you are an intern or a fifth year, no one is learning after 10 hours and once you pass 12 you're becoming a danger to your patients. We got to 80 hour weeks after someone died and the ACGME wants to go back to what we had before. Sounds like a lawyers wet dream.

 

[Jlaw]

So, 16 X 5 is totally doable and might even be a relatively humane schedule. Set it up so that several days of the same "shift" are grouped together whenever possible. So, either 7a-11p or 7p-11a. Gives 4 hours of overlap on either end, resolving the issues with hand off. You'd also potentially have twice as many hands for both the 7-11a and 7-11p hours, which are both busy times of day. Your attendings could keep a 9-5 schedule if they wanted and still be able to see all the interns every day.

Doing the same shift several days in a row minimizes the pain of switching back and forth between days and nights and gives the potential for real time off every week, maybe even a rare 3 or 4 day stretch if the stars aligned just right. (What? I know, right?)

The problem, as you notice, is that this would require more interns. Yup. But not a lot more. The minimum that such a system could work with would be 4, assuming no absences, vacations, etc. But it could work seamlessly at any program with 5+ interns, or a willingness to use nonresident night float to cover some of the shifts.

7a-11p??? So add in commute, showering, eating, winding down, and the interns are getting like 4 hours of sleep. I'm not even a lawyer but if I bet I could get 8 figures out of a jury if you killed someone on that schedule.

 

[ProfMD]

28 hour shifts are literally ******ed. I don't care if you are an intern or a fifth year, no one is learning after 10 hours and once you pass 12 you're becoming a danger to your patients. We got to 80 hour weeks after someone died and the ACGME wants to go back to what we had before. Sounds like a lawyers wet dream.

Who wants to go back to pre-80 hour days? No one has proposed that.

And I would contend that learning does extend beyond 10 hours and it does take more than 12 to become a danger. This is all from my own experience and the available data.

 

[Promethean]

7a-11p??? So add in commute, showering, eating, winding down, and the interns are getting like 4 hours of sleep. I'm not even a lawyer but if I bet I could get 8 figures out of a jury if you killed someone on that schedule.

There are a lot of people who work 16 hour shifts. Heck, I've done 5 in a week before. You don't get to commute that far (better live close by!) or spend any time "winding down" whatever that means. It is a dismal life of eat, sleep, work, nothing else on work days. But how exactly do you expect that you are going to be getting 80 hours a week in otherwise?

The alternative is 24+4 hour shifts mixed in with 4 x 13 hour shifts. 7a-8p isn't exactly an extreme improvement.

You are right, it is brutal. And excessive. But the folks who trained with 120 hour weeks don't have a lot of sympathy for our complaints.

 

[Jlaw]

There has definitely been talk about loosening the 80 hour week, I've heard it at my institution and others. And where else would you be going with 28 hour shifts?

 

[WheezyBaby]

Long call and short call have their respective pros and cons and more or less offset one another imo. Don't think one model of really superior to the other, though that can depend on the service. In general I think higher acuity settings do better with long call

In my program it meant having to go to DOMAs ("Day off My Ass") - i.e. using the 24 hr period where you transition from nights to days as a "day off".

^these SOBs are some bull **** though

 

[ProfMD]

There has definitely been talk about loosening the 80 hour week, I've heard it at my institution and others. And where else would you be going with 28 hour shifts?

Nobody with any authority is talking about loosening the 80 hour week. Since 2003, when the rule was instituted, there has been a provision for a 10% extension. Otherwise, the only rule they are talking about getting rid of is the 16 hour shifts for interns which is relatively new.

28 hour shifts have also been around since the 80 hour week was instituted in 2003. The 16 hour rule for interns came more recently. Residents other than interns live by this rule now.

 

[Jlaw]

There are a lot of people who work 16 hour shifts. Heck, I've done 5 in a week before. You don't get to commute that far (better live close by!) or spend any time "winding down" whatever that means. It is a dismal life of eat, sleep, work, nothing else on work days. But how exactly do you expect that you are going to be getting 80 hours a week in otherwise?

The alternative is 24+4 hour shifts mixed in with 4 x 13 hour shifts. 7a-8p isn't exactly an extreme improvement.

You are right, it is brutal. And excessive. But the folks who trained with 120 hour weeks don't have a lot of sympathy for our complaints.

16x5 for a week as a medical student is a lot different than 16x5 for a few years as a resident. People have lives and families. Our predecessors were abused and extorted by the system, if thats what medicine required now I would take my talents elsewhere.

 

[ProfMD]

16x5 for a week as a medical student is a lot different than 16x5 for a few years as a resident. People have lives and families. Our predecessors were abused and extorted by the system, if thats what medicine required now I would take my talents elsewhere.

That is what medicine in the US requires. During at least some parts of your training for sure and may also happen from time to time as an attending.

Surely you new this before signing up for medicine?

 

[Jlaw]

Nobody with any authority is talking about loosening the 80 hour week. Since 2003, when the rule was instituted, there has been a provision for a 10% extension. Otherwise, the only rule they are talking about getting rid of is the 16 hour shifts for interns which is relatively new.

28 hour shifts have also been around since the 80 hour week was instituted in 2003. The 16 hour rule for interns came more recently. Residents other than interns live by this rule now.

Ok so what is the benefit of 28 hour shifts? You really think an intern who has been on shift for 25 hours so probably awake for 27+ is learning? Are they making safe decisions? No, they are just trying to survive until they hit 28 hours so they can leave and try not to kill themselves or anyone else on the way home. Would you want them caring for yourself or your kids? Would you want your wife driving near them on the way home from a 28 hour shift? I wouldn't. If they took care of a family member and it went sideways would you sue? I would.

 

[Jlaw]

That is what medicine in the US requires. During at least some parts of your training for sure and may also happen from time to time as an attending.

Surely you new this before signing up for medicine?

I practice medicine in the US and I've never been required to do anything close to this.

 

[ProfMD]

Ok so what is the benefit of 28 hour shifts? You really think an intern who has been on shift for 25 hours so probably awake for 27+ is learning? Are they making safe decisions? No, they are just trying to survive until they hit 28 hours so they can leave and try not to kill themselves or anyone else on the way home. Would you want them caring for yourself or your kids? Would you want your wife driving near them on the way home from a 28 hour shift? I wouldn't.

The last 4 hours are for wrapping up notes and handover. No new patients after 24 hours. I have done it, lots of people have done it. I can honestly say that I never felt I was endangering patients.

I practice medicine in the US and I've never been required to do anything close to this.

Did you train in the US? With rare exception, I am not aware of any training program that would not require at least a few months of extended shifts.

 

[chipwhitley]

That is what medicine in the US requires. During at least some parts of your training for sure and may also happen from time to time as an attending.

Surely you new this before signing up for medicine?

That is, unless you happen to be a midlevel practicing medicine in the US - then you can get away with a fraction of the schooling, no residency, more money right out of school, and if you're lucky enough to be an NP you can even get full practice rights! And you'll never get forced to work a 28 hour shift your entire life!

 

[Jc2008]

28 hour shifts are literally ******ed. I don't care if you are an intern or a fifth year, no one is learning after 10 hours and once you pass 12 you're becoming a danger to your patients. We got to 80 hour weeks after someone died and the ACGME wants to go back to what we had before. Sounds like a lawyers wet dream.

If lawyers could only sue us out of this predicament and back into saner work life balance that would be great. Unfortunately (and I am one), they can't because the laws are stacked against employee rights and towards business interests.

 

[Jlaw]

If lawyers could only sue us out of this predicament and back into saner work life balance that would be great. Unfortunately (and I am one), they can't because the laws are stacked against employee rights and towards business interests.

Money rules, no one cares about your work life balance, they care about getting sued into oblivion because you f*ck up 2/2 being over worked.

 

[Jlaw]

The last 4 hours are for wrapping up notes and handover. No new patients after 24 hours. I have done it, lots of people have done it. I can honestly say that I never felt I was endangering patients.



Did you train in the US? With rare exception, I am not aware of any training program that would not require at least a few months of extended shifts.

A lot of people were nazis, doesn't mean it was right. I'm training in the US currently, don't think we work more than 14 hours at a time ever. You never answered my question, would you let a resident at 25 hours sew up your daughters forehead lac or take your son to the OR for an appy?

 

[ProfMD]

A lot of people were nazis, doesn't mean it was right. I'm training in the US currently, don't think we work more than 14 hours at a time ever. You never answered my question, would you let a resident at 25 hours sew up your daughters forehead lac or take your son to the OR for an appy?

With appropriate supervision, yes.

At least in my program, the initial evaluation was done by the junior resident - maybe in their 24th hour. However, there was always a better rested senior and attending do make the higher level decisions and do the cases.

 

[Promethean]

16x5 for a week as a medical student is a lot different than 16x5 for a few years as a resident. People have lives and families. Our predecessors were abused and extorted by the system, if thats what medicine required now I would take my talents elsewhere.

I haven't always been a medical student. LOL at the idea of a med student considering their schedule to be anything remotely like a 16 hour shift.

I'm not saying that a 16 x 5 week is humane or a great way to spend one's time. I'm saying that it is one of the least painless ways to work an 80 hour week. From someone who has actually worked 60-80 hour weeks for years, while having a life and family.

This is what medicine requires now. This is the relaxed schedule. Don't get it in your head that there isn't still plenty of exploitation in this system. But if you want to practice medicine, this is where it is at.

There are only 168 hours in a week. 80 (+ whatever you have to do off the books in order to fulfill unofficial expectations) of them are spoken for by your residency program. The ACGME has already decided that it is cool if your program wants to make you do upto 28 hour shifts in your 1st year, where currently only 2nd years and up have to do that nonsense. Understand that is what I'm arguing against... even though it is basically a done deal.

 

[Winged Scapula]

The dark ages were even longer. 36 hour shifts were common just a generation ago.

It wasn't that long ago (a generation is typically defined as 25 years); the first work hour restrictions outside of NY state were in 2003.

 

[Gastrapathy]

28 hour shifts are literally ******ed. I don't care if you are an intern or a fifth year, no one is learning after 10 hours and once you pass 12 you're becoming a danger to your patients. We got to 80 hour weeks after someone died and the ACGME wants to go back to what we had before. Sounds like a lawyers wet dream.

I learned more after the 10th hour than before. No attending to be seen. Cross cover and procedures on sick patients. ICU hijinks. A 16 hour shift with 10 hours off was always stupid. Only a committee could create a 26 hour cycle.

 

[Gastrapathy]

It wasn't that long ago (a generation is typically defined as 25 years); the first work hour restrictions outside of NY state were in 2003.

Thank you. I feel 10% less old now.

 

[Promethean]

A lot of people were nazis, doesn't mean it was right. I'm training in the US currently, don't think we work more than 14 hours at a time ever. You never answered my question, would you let a resident at 25 hours sew up your daughters forehead lac or take your son to the OR for an appy?

Wow. You just compared being expected to work (an admittedly quite long) shift to genocide and mass murder. Guess we're done here.

 

[Promethean]

It wasn't that long ago (a generation is typically defined as 25 years); the first work hour restrictions outside of NY state were in 2003.

You got your generations, I've got mine. 25 years? Heck, where I come from, there are 25 year old grandmothers. But for you, I will concede "half a generation ago."

 

[Jlaw]

I haven't always been a medical student. LOL at the idea of a med student considering their schedule to be anything remotely like a 16 hour shift.

I'm not saying that a 16 x 5 week is humane or a great way to spend one's time. I'm saying that it is one of the least painless ways to work an 80 hour week. From someone who has actually worked 60-80 hour weeks for years, while having a life and family.

This is what medicine requires now. This is the relaxed schedule. Don't get it in your head that there isn't still plenty of exploitation in this system. But if you want to practice medicine, this is where it is at.

There are only 168 hours in a week. 80 (+ whatever you have to do off the books in order to fulfill unofficial expectations) of them are spoken for by your residency program. The ACGME has already decided that it is cool if your program wants to make you do upto 28 hour shifts in your 1st year, where currently only 2nd years and up have to do that nonsense. Understand that is what I'm arguing against... even though it is basically a done deal.[/QUOTE

It might be where medicine is but it doesn't mean we let them f*ck us any harder. Take the 28 call and shove it up their....

I dont care about me i'll be done, i'm warning the next generation.

 

[Gastrapathy]

A lot of people were nazis, doesn't mean it was right. I'm training in the US currently, don't think we work more than 14 hours at a time ever. You never answered my question, would you let a resident at 25 hours sew up your daughters forehead lac or take your son to the OR for an appy?

I'd never let a resident do anything to my kid. I wouldn't let most attendings touch my kid. I hope you plan on having a pure clinic or shift work practice because there are no work hours in the real world.

 

[Jlaw]

Wow. You just compared being expected to work (an admittedly quite long) shift to genocide and mass murder. Guess we're done here.

So I'll ask for the third time, do you let the resident at 2X hours suture/operate/talk to your fam? I'm guessing by your avoidance of the question that the answer is no and you are afraid that admitting that would weaken your argument? It does.

 

[Jlaw]

I'd never let a resident do anything to my kid. I wouldn't let most attendings touch my kid. I hope you plan on having a pure clinic or shift work practice because there are no work hours in the real world.

I'm EM, shift work.

 

[Gastrapathy]

So I'll ask for the third time, do you let the resident at 2X hours suture/operate/talk to your fam? I'm guessing by your avoidance of the question that the answer is no and you are afraid that admitting that would weaken your argument? It does.

What do you think the typical schedule of a private practice surgeon who would be performing emergency surgery in the middle of the night is? Do you think they are working a 12 hour night shift?

When you call the GI doc or Cardiologist at 2 am, you do realize that we aren't there and we were the same guy you called the last night right?

 

[Promethean]

So I'll ask for the third time, do you let the resident at 2X hours suture/operate/talk to your fam? I'm guessing by your avoidance of the question that the answer is no and you are afraid that admitting that would weaken your argument? It does.

I'm going to try to be polite.

You never asked me this the first time. You were quoting someone else. (Someone who did answer you.)

You don't even know who you are arguing with at this point. I've been on the side of shorter (merely 16 hour!) shifts from the start. I put my name on it when I sent in my commentary to the ACGME. Did you do anything substantive? Or are you just raging on a forum about something that you admit isn't really going to affect you?

I will do you the courtesy of answering you, though: If I or my family end up in hospital, I'm going to trust that the folks providing care to me are capable of doing so. No, I'm not going to ask them when they last slept, unless they give me some cause to be concerned. Advocacy happens before you get into that situation. When you are there? I'm certainly not going to ask for a higher standard of care than any other patient would get.

 

[Gastrapathy]

I will do you the courtesy of answering you, though: If I or my family end up in hospital, I'm going to trust that the folks providing care to me are capable of doing so. No, I'm not going to ask them when they last slept, unless they give me some cause to be concerned. Advocacy happens before you get into that situation. When you are there? I'm certainly not going to ask for a higher standard of care than any other patient would get.

This is a little off topic but I get asked to see family members by other physicians when I'm not on call. I scoped a physician last week at her request rather than her being scoped by the on-call GI. You'll see that happen all the time (and can't take it personally when you are the one that gets bypassed). It goes a very long way to establishing your reputation when you are gracious with these requests.

 

[Promethean]

This is a little off topic but I get asked to see family members by other physicians when I'm not on call. I scoped a physician last week at her request rather than her being scoped by the on-call GI. You'll see that happen all the time (and can't take it personally when you are the one that gets bypassed). It goes a very long way to establishing your reputation when you are gracious with these requests.

I have seen it happen all the time. I've been running the OR schedule when one of our surgical or anesthesia attendings would bring in their kid with a broken arm or lac and cautiously ask "So, who's on call for ortho?" When the answer came back the wrong way, they had us quietly page the doc they wanted so that they could ask that favor.

I'd never be offended. Of course, I'm FM bound, so it isn't likely to happen to me so much. But yeah, it is just one of those things. People are weird about who takes care of their kid. You gotta roll with that.

 

[Promethean]

I'm EM, shift work.

So totally without a dog in this fight. Noted.

I begin to appreciate why the PDs are so concerned about the development of a shift work mentality among interns.

 

[Gastrapathy]

...Of course, I'm FM bound, so it isn't likely to happen to me so much. But yeah, it is just one of those things. People are weird about who takes care of their kid. You gotta roll with that.

It definitely happens in primary care. My kids doc has the misfortune of having collected up half the doctor's kids in the neighborhood.

 

[Winged Scapula]

A lot of people were nazis, doesn't mean it was right. I'm training in the US currently, don't think we work more than 14 hours at a time ever. You never answered my question, would you let a resident at 25 hours sew up your daughters forehead lac or take your son to the OR for an appy?

What makes you think the attending hasn't been working those kind of hours?

There are no work hour restrictions for attendings in practice. You take your child to a surgeon, especially those without resident coverage and its entirely possible they've been up for that long.

NB: I see that @Gastrapathy had the same post which hadn't loaded when I was typing mine (I"m mid-air).

 

[Mr Roboto]

I learned more after the 10th hour than before. No attending to be seen. Cross cover and procedures on sick patients. ICU hijinks. A 16 hour shift with 10 hours off was always stupid. Only a committee could create a 26 hour cycle.

In that case, the difference isn't that you were there for the 10th hour. That's like saying "oh this patient got better because the bed has blue sheets." No.

 

[Gastrapathy]

In that case, the difference isn't that you were there for the 10th hour. That's like saying "oh this patient got better because the bed has blue sheets." No.

The increased responsibility and autonomy that comes with working more (and particularly later) than the attendings was a casualty of the work hours rules. The current set of rules marginalizes interns even more.

 

[lymphocyte]

This is what happens in a system where employees (residents) have little to no rights, just like employees everywhere in the US. Look at rules governing residencies in other developed countries with similar physician salaries and medical outcomes. There are NO developed countries where working people like this is legal. It is not necessary, not humane, not smart and all excuses and explanations of why it is necessary are BS.

That's not true.

I just inked a residency contract in Australia. Here, we are scheduled to work 38hrs/week, but that doesn't include overtime, which everybody gets assigned. Including overtime, residents work 50-60 hours/week, though it often exceeds 70 during busier rotations. There is no cap. Only three things limit hours: 1) tradition, 2) common decency, and 3) overtime being paid at increasingly steep penalty rates. The law says there should be a minimum of 8 hours between shifts, but just like with anything, people game the system to their own benefit. Residents who want to impress don't whinge (or claim overtime), and residents who have outside obligations trade off their shifts. I appreciate the flexibility, and it seems closer to a "free-market" system where people and institutions can prioritise their preferences.

At the same time, residents have to prepare for specialty training. Doctors don't specialise directly after medical school. They work at least a year as a house officer first. During that time, they're not only expected to work, but they also have to buff up their CV, since specialty training spots are hard to come by. It's not uncommon for people do to 3-5 house officer years to gather all the publications, references, and ancillary qualifications they need to be competitive, especially for surgical specialties.

I've done 4 Sub-I's in the US, so I have some sense of the American system. There are pros and cons to both. The American system is shorter, but the Australian system 1) pays better (some interns make 6 figures from overtime), 2) medical school is heavily subsidised, and 3) the system is more humane when it comes to things like maternity leave, taking extended leave, or dealing with health issues. 1-3 means people are more amenable to longer training. Also, residents that want competitive specialties simply work harder. There's no shortcut to becoming a qualified surgeon, regardless of where you train.

 

[Jc2008]

That's not true.

I just inked a residency contract in Australia. Here, we are scheduled to work 38hrs/week, but that doesn't include overtime, which everybody gets assigned. Including overtime, residents work 50-60 hours/week, though it often exceeds 70 during busier rotations. There is no cap. Only three things limit hours: 1) tradition, 2) common decency, and 3) overtime is paid at an increasingly steep penalty rate. The law says there should be a minimum of 8 hours between shifts, but just like with anything, people game the system to their own benefit. Residents who want to impress don't whinge (or claim overtime), and residents who have outside obligations trade off their shifts. I appreciate the flexibility, and it seems closer to "free-market" system where people and institutions can prioritise their preferences.

At the same time, residents have to prepare for specialty training. Doctors don't specialise directly after medical school. They work at least a year as a house officer first. During that time, they're not only expected to work, but they also have to buff up their CV, since specialty training spots are hard to come by. It's not uncommon for people do to 3-5 house officer years to gather all the publications, references, and ancillary qualifications they need to be competitive, especially for surgical specialties.

I've done 4 Sub-I's in the US, so I have some sense of the American system. There are pros and cons to both. The American system is shorter, but the Australian system 1) pays better (some interns make 6 figures), 2) medical school is heavily subsidized, and 3) the system is more humane when it comes to things like maternity leave, taking extended leave, or dealing with health issues. 1-3 means people are more amenable to longer training. Also, residents that want competitive specialties simply work harder. There's no shortcut to being a qualified surgeon, regardless of where you train.

Still sounds like a better system to me...being a surgeon takes more hours everywhere for sure. My point is that it does not have to be that way and that surgery benchmarks don't need to be applied in other specialties. Australia is US - lite system...like the UK. If you go to Western Europe or northern europe you will encounter very different attitudes.

 

[lymphocyte]

Still sounds like a better system to me...being a surgeon takes more hours everywhere for sure. My point is that it does not have to be that way and that surgery benchmarks don't need to be applied in other specialties. Australia is US - lite system...like the UK. If you go to Western Europe or northern europe you will encounter very different attitudes.

It's actually not like the UK, and that's why Australia has an annual deluge of junior doctors escaping the NHS. Less hours sound great, but when it comes to becoming a competent doctor, the pied piper must be paid.

And surgical standards aren't applied to other specialties. Which psychiatry programme works its residents like surgical trainees? Just because a programme can, doesn't mean a programme will, because requirements for competency vary from specialty to specialty. We're talking about limits here, not benchmarks.

More to the point: the prestige of the profession was not earned by us, but by the doctors that came before us. They should decide, not us, what it takes to become a doctor, because it's their profession we aspire to join. The entitlement mentality I sometimes see in medical students is nauseating. Just reading over the other threads in this forum: we want to work less, get paid a lot, not worry about mid-levels--give me a break. In what other profession would this kind of discussion be tolerated? (As an aside, there are a lot of poor Americans for whom 80/hrs week is a way of life and no kind of ticket to a better one.)

When medicine becomes "our" profession, we can change the rules all we want and hope we don't turn ourselves into just another shift-working commodity, as is already starting to happen. And if we don't want government intervening when we're attendings, I'm not sure why we should invite its intervention when it comes to our training.

 

[Jc2008]

It's actually not like the UK, and that's why Australia has an annual deluge of junior doctors escaping the NHS. Less hours sound great, but when it comes to becoming a competent doctor, the pied piper must be paid.

And surgical standards aren't applied to other specialties. Which psychiatry programme works its residents like surgical trainees? Just because a programme can, doesn't mean a programme will, because requirements for competency vary from specialty to specialty. We're talking about limits here, not benchmarks.

More to the point: the prestige of the profession was not earned by us, but by the doctors that came before us. They should decide, not us, what it takes to become a doctor, because it's their profession we aspire to join. The entitlement mentality I sometimes see in medical students is nauseating. Just reading over the other threads in this forum: we want to work less, get paid a lot, not worry about mid-levels--give me a break. In what other profession would this kind of discussion be tolerated? (As an aside, there are a lot of poor Americans for whom 80/hrs week is a way of life and no kind of ticket to a better one.)

When medicine becomes "our" profession, we can change the rules all we want and hope we don't turn ourselves into just another shift-working commodity, as is already starting to happen. And if we don't want government intervening when we're attendings, I'm not sure why we should invite its intervention when it comes to our training.

Me and you, friend, have very different views on life and medicine. I don't think it's anybody's profession and nobody can claim it as their own. I don't think entitlement , as you call it, is a problem - I think it's a solution to a really ****ed up system steeped in non-sensical tradition and parochialism. Young docs need to raise up and break out of this idiocy and people like you are not helping. I think you misunderstood my comment, I'm not against government intervention - I'm for it (despite my picture). Fact that many people work 80 hours of week for paycheck to paycheck is not a reason we should aspire to the same, it's a reason why docs should be getting paid less and why there should be more equality in society. I have a feeling this will fall on (your ) deaf ears.

 

[Jc2008]

It's actually not like the UK, and that's why Australia has an annual deluge of junior doctors escaping the NHS. Less hours sound great, but when it comes to becoming a competent doctor, the pied piper must be paid.

And surgical standards aren't applied to other specialties. Which psychiatry programme works its residents like surgical trainees? Just because a programme can, doesn't mean a programme will, because requirements for competency vary from specialty to specialty. We're talking about limits here, not benchmarks.

More to the point: the prestige of the profession was not earned by us, but by the doctors that came before us. They should decide, not us, what it takes to become a doctor, because it's their profession we aspire to join. The entitlement mentality I sometimes see in medical students is nauseating. Just reading over the other threads in this forum: we want to work less, get paid a lot, not worry about mid-levels--give me a break. In what other profession would this kind of discussion be tolerated? (As an aside, there are a lot of poor Americans for whom 80/hrs week is a way of life and no kind of ticket to a better one.)

When medicine becomes "our" profession, we can change the rules all we want and hope we don't turn ourselves into just another shift-working commodity, as is already starting to happen. And if we don't want government intervening when we're attendings, I'm not sure why we should invite its intervention when it comes to our training.

If you want a sane system where people are valued over tradition and nonsense business interests, look at Skandinavia, Northern Europe, germany etc. ....US and its carbon copies (UK, australia) are no way to run a society

 

[lymphocyte]

Me and you, friend, have very different views on life and medicine. I don't think it's anybody's profession and nobody can claim it as their own. I don't think entitlement , as you call it, is a problem - I think it's a solution to a really ****ed up system steeped in non-sensical tradition and parochialism. Young docs need to raise up and break out of this idiocy and people like you are not helping.

I'm sure when "young docs need to raise up and break out of the idiocy" they will turn to pre-allos like yourself for advice.

 

[Jc2008]

I'm sure when "young docs need to raise up and break out of the idiocy" they will turn to the pre-allos for advice.

Oh that is rich, buddy. You should run for president or something with all that knowledge and gravitas you have as a medical student. I'm sure this is your first grad school too, so you must feel pretty smart and mighty. Keep learning buddy, one day you'll get it.

 

[deleted480308]

Me and you, friend, have very different views on life and medicine. I don't think it's anybody's profession and nobody can claim it as their own. I don't think entitlement , as you call it, is a problem - I think it's a solution to a really ****ed up system steeped in non-sensical tradition and parochialism. Young docs need to raise up and break out of this idiocy and people like you are not helping. I think you misunderstood my comment, I'm not against government intervention - I'm for it (despite my picture). Fact that many people work 80 hours of week for paycheck to paycheck is not a reason we should aspire to the same, it's a reason why docs should be getting paid less and why there should be more equality in society. I have a feeling this will fall on (your ) deaf ears.

More income equality? Screw that