but if you recognize that occasionally crap happens, you keep the original plan low enough to account for crap happening. 16hrs with an occasional crap happens is quite literally 8hrs better than 24hrs with occasional crap happening.
A resident can escape to the call room to catch even a 15-30 minute nap. A nurse caught sleeping on the job would be fired.
I apologize if this sounds terse, but the "who is going to pay for all the extra help if the resident don't work the extra time?" really isn't the residents problem. It simply doesn't matter. That's the system's problem and not theirs. You may choose to work 24hr shifts but you can choose, and the VAST majority of attendings across most fields don't do 28hr shifts anymore and they don't work 320hrs/month. These resident can't refuse and we all know it. You simply can't tell the people already working the most hours in the hospital that they need to work more because they are also the only ones who can have their hours increased for free.
But the system just wants to lay this back on the most powerless cohort.
This is precisely the type of faculty attitude that necessitates ACGME hour restrictions...
That's your answer to a broken system that's pushing people to commit suicide?
The way things were each resident had less patients to cover since you weren't dumping everything to the night float guy. You also were primarily covering your service so you know more about the patients and can handle issues more efficiently rather than finding the random patient on your sign out sheet, re reading the chart, and evaluating the patient from scratch.
"Worse" is a sort of relative term. You'll be more tired pulling 4x12+2x16 than you will be after pulling 2x28+1x24 in a 7 day span.
It's sad that this is coming from doctors, the same people whose job it is to encourage people to have a healthy lifestyle.
I've done manual labor on scale with those hours....it all stinks. But let's be honest it's not like they want to stick to 80hrs. This is just a progression to move the 80hr limit too
And while they'll argue that 80 hrs/week of non-stop work for 3-5 years isn't enough for us to be safe as independent practitioners, DNPs are setting up shop with 500 hours of shadowing. Nice job America.
Your points primarily have to do with surgical specialties. One of the issues here is that the same rules are being applied to every field, which is not right. I do not need to spend all night in the hospital, being paged every 15 minutes because someone is itching, to be a good internist. What I do need is time for reading and studying, which I barely have. Non-surgery residents on average are not happy with 28 hour calls.
Yes, except that the documents from the ACGME did not say anywhere that this change would be limited to surgeons? http://www.acgme.org/Portals/0/PDFs/CPRNewsRelease_Fall2016_FINAL.pdf
So are you going to stick with your patient 24 hours a day, 365 days a year until your patient dies? When's the last time you did a 28 hour shift as an attending? Turnovers, shifts, etc are part of every job in healthcare (and every job in the world), no reason why we should be different. You own your patients while you're taking care of them - that's your job. And the next guy should do the same. Your job is not to be there forever.
Except NPs and PAs cost the government nothing, so it makes more sense from a policy effort to encourage expansion of their training than to train more physicians.
Ah, the libertarian that doesn't like others setting the rules for him in a contract in exchange for a service. How ironic.
govt enforced monopoly.....completely changes the rules.
Even without the government, there were physician guilds stretching back thousands of years. They ensured their stranglehold on training by essentially excommunicating anyone that broke their rules in regard to how to train others and what costs were expected in exchange, and blackballing anyone that trained with a person cast out of the guild. It was the same stranglehold they hold today, albeit by a different mechanism. Eventually governments got involved in codifying guilds as the de facto practitioners of their given craft, but there was a long pre-government history of professions and guilds.
You're joking right? Back in the days physicians had a much better life. Almost universal respect, no mountains of paperwork, EMRs, billing and coding, quality metrics, notes that are pages and pages long with little substance and "documentation experts" telling us to rewrite our notes, insurance company MBAs telling us how to do our jobs, nurses thinking they can do our jobs with an online degree... shall I go on and on? No, back in the day we did one thing and one thing only - take care of patients.
I'm aware of the history or professions forming guilds and trying ostracize those that don't keep in step. But if your trade is painting and the other painters don't want to talk to me because I didn't jump through the painting guild hoops, I can still paint things. You may choose to not rent gallery space to me from the guild but I can still ply my trade.
I was referring to medicine as practiced in ancient Greece and China. Up until recently, physicians in the West were actually very poorly regarded- it was not until the late 19th and early 20th century that physicians became practitioners of a prestigious profession, before that they were viewed as butchers you would see as a last resort, just after praying and just before you received the last rites. Even then, physician incomes were not very high- physicians made the equivalent of about $50,000/year in today's dollars until the establishment of Medicare and entrenchment of the insurance industry (which has a very interesting history itself- wage controls were established during WWII, so employers offered non-wage benefits like private health insurance to entice employees). With the ability to charge insurers rather than patients, physicians found they could get much larger sums for their services. Anesthesiologists, for instance, were taking in 700k in 1970s dollars during the golden age of medicine. But that was a very short lived period, as the government caught on and changed payment models to bring skyrocketing physician compensation back down to earth. First this came in the form of fixed payments and then reduced payments, and finally a push for managed care models. But as much as you and I all hate the system and the government, without them we wouldn't have reached the point where we're making the wages we're making. Wage controls and Medicare brought us our riches, and paperwork and regulation was the devil's bargain our forebears made to make that happen.
I understand that feeling and wasn't trying to rabbit trail. I was expressing that the current setup isn't really free market so the same self-correcting forces don't really apply.
When you said "back in the day", I didn't realize we were going back into ancient history, lol. I was referring to the 1970s and 80s.
Still, he made it sound like physicians were always this well respected profession. We didn't really earn much respect until the advent of antibiotics, and didn't earn much money until the proliferation of insurance, which was an accident largely brought on accidentally by government intervention, not design.
Except you couldn't really go out and practice independently because guilds often controlled the supplies and knowledge with which one would do their job, or would contract out to those who could make such equipment with the understanding that only they would be supplied with it in exchange for the business of the whole guild. That's why there are few instances of successfully competing guilds throughout history- to compete either required one to make everything necessary for their profession themselves, resulting in an inferior product, or would have to form a group large enough from the outset to outbud the guild in supply acquisition, which was all but impossible in most situations.
but the guild couldn't get me arrested for plying my trade if I left the guild....I feel we're rabbit trailing here
Except they already studied the issue in depth for several years, and it didn't result in more harm to patients and most of the residents liked the 24 hour shifts better than the 16 hour ones. http://www.jhcct.org/icompare/default.asp
do you have a link to the results? because that link doesn't support your statement
http://www.acgme.org/What-We-Do/Accreditation/Clinical-Experience-and-Education-formerly-Duty-Hours
