Longer Shifts for First-Year Residents to Start in July

[Crayola227]

Hmmm. What does petty crime imprisonment have to do with this discussion? You want them to release criminals so we can have more residents?

Genius, this will likely increase case load for the residents. Circular solution of elegance.

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Members don't see this ad.

 

[2021Doctor]

So cynical.

My motivation for expanding work hours is to make sure my residents get the necessary experience.

Imo most attendings definition of "the necessary experience" is crap.
They train based on technology of yesterday and today.
They do not train for the future.
Residents need to learn how to think and act like physicians and gain basic skills that may help them adapt to future changes.

Any surgery residency programs that are not preparing their residents to use Google's Verb system are not really training surgeons for the future, they are training surgeons for the present and past.

“We went out and looked at the market, and after, [Conrad] came back and said, ‘That’s not a robot,’” Pruden told us. “All that is is an extension of the physician’s eyes and hands. A robot is supposed to tell you valuable information that’s going to help guide you, it will do some things automatically for you. It will use Big Data, it would use anatomical recognition software, things of that nature, which are currently not available today.”
http://www.massdevice.com/jj-googles-verb-surgical-looks-define-lift-robotic-surgery/

 

[SurfingDoctor]

What constitutes a "prisoner" is a matter of legislative policy. Many of those in prison shouldnt be, but the current laws on the books gives judges little discretion (many admit their hands are tied).

Were all potentially "criminals." Blow a stop sign lately? I have.

People go to prison for running a Stop sign?

 

[Azete]

People go to prison for running a Stop sign?

If you hit and/or injure somebody. There's a lot of innocuous traffic violations that can send you to prison for a long time under the right circumstances.

 

[Light at end of tunnel]

People go to prison for running a Stop sign?

Indirectly, they sure can.

But, if we got a frenzied group of lawmakers who for whatever may be the instant political climate decided to make blowing a stop sign a felony (which they can do with enough "votes"), then directly as well.

Laws are man made.

 

[saveourpens]

Which is (a) a typically false assumption, (b) doesn't take into account the other months where you work half that, (c) ignores the other professional level benefits you get as a resident, and (d) once again ignores the fact that you are in training, not a terminal employment position.

Well thank god after 8 years of schooling, for certain months, I'll be making more than the person who makes my sandwich and even have some benefits.

You make fair points, but they're part of a complacent attitude that, adjusting for inflation, has led to the same absurdly low stagnant resident salary for the past 40 years.

Sure, it's a temporary training position. Does that give hospitals the right to collude and systematically limit resident salary?

I can't believe how many here are willing to go against their own self interest. In the words of someone who helped found UPMC, "of course residents are taken advantage of. Better to pay one 50k then an NP 100k".

 

[ProfMD]

Imo most attendings definition of "the necessary experience" is crap.
They train based on technology of yesterday and today.
They do not train for the future.
Residents need to learn how to think and act like physicians and gain basic skills that may help them adapt to future changes.

Any surgery residency programs that are not preparing their residents to use Google's Verb system are not really training surgeons for the future, they are training surgeons for the present and past.

“We went out and looked at the market, and after, [Conrad] came back and said, ‘That’s not a robot,’” Pruden told us. “All that is is an extension of the physician’s eyes and hands. A robot is supposed to tell you valuable information that’s going to help guide you, it will do some things automatically for you. It will use Big Data, it would use anatomical recognition software, things of that nature, which are currently not available today.”
http://www.massdevice.com/jj-googles-verb-surgical-looks-define-lift-robotic-surgery/

What?

I'm sorry, but you have no idea what it takes to train a surgeon.

 

[Light at end of tunnel]

Well thank god after 8 years of schooling, for certain months, I'll be making more than the person who makes my sandwich and even have some benefits.

You make fair points, but they're part of a complacent attitude that, adjusting for inflation, has led to the same absurdly low stagnant resident salary for the past 40 years.

Sure, it's a temporary training position. Does that give hospitals the right to collude and systematically limit resident salary?

I can't believe how many here are willing to go against their own self interest. In the words of someone who helped found UPMC, "of course residents are taken advantage of. Better to pay one 50k then an NP 100k".

Thats exactly it you see - it is the norm to take advantage of residents.

Society is largely ok with it. Sort of like institutional hazing which gives rise to the "better them than me" mentality.

The sense of a need to disenfranchise residents bf finally letting them be attendings is fiber intrinsic to our culture at large.

You dont want to be hazed? Well then, you cant join our fraternity.

 

[SurfingDoctor]

and what if the longer track was for like single parents, or residents with medical conditions, people we thought would be kick ass docs and able to adjust as attendings, but needed a little more forgiving # hrs/day/week as residents to get there???

let me bask in the fantasy, before we unzip to piss on the weak

Personally, I would be fine with it, though again the logistics would likely be problematic.

As for being an attending, there are no forgiving hours. If you're on service or on call and someone in your family has a medical emergency, one can't just leave. People may not like that, but it's reality.

 

[SurfingDoctor]

I will say in general, when I've seen trainees walk around with chips on their shoulder... they go on to have rough careers. No one wants to hire or work with people who complain and are grumpy all the time.

 

[HotLunch96]

Well thank god after 8 years of schooling, for certain months, I'll be making more than the person who makes my sandwich and even have some benefits.

You make fair points, but they're part of a complacent attitude that, adjusting for inflation, has led to the same absurdly low stagnant resident salary for the past 40 years.

Sure, it's a temporary training position. Does that give hospitals the right to collude and systematically limit resident salary?

I can't believe how many here are willing to go against their own self interest. In the words of someone who helped found UPMC, "of course residents are taken advantage of. Better to pay one 50k then an NP 100k".

Resident pay is dictated by government while NP salary is dictated by the market. And I don't buy the argument that revenue generated + government stipend - "cost" of educating residents is a net loss for hospitals. They're businesses; the CFO wouldn't allow that to happen. Residents are most definitely exploited labor.

 

[SurfingDoctor]

If you hit and/or injure somebody. There's a lot of innocuous traffic violations that can send you to prison for a long time under the right circumstances.

Indirectly, they sure can.

But, if we got a frenzied group of lawmakers who for whatever may be the instant political climate decided to make blowing a stop sign a felony (which they can do with enough "votes"), then directly as well.

Laws are man made.

What does any of this have to do with the topic of the thread?

 

[Winged Scapula]

You'd be surprised how many med school applicants there are who have no idea the hours involved with residency.

When most premeds shadow they spend maybe a few hours at a time in the hospital and rarely more than 12 hours. I've been saying this for years but I really think that before anyone is allowed to apply to med school they should shadow a surgical or medical resident for a whole week including at least one overnight 28 hour call.

Even medical students don't understand.

I had a 4th year with me recently who said to me, "You have a pretty good lifestyle, we only worked from 8 to 430 yesterday".

My response? "Yes I do have a good lifestyle, but what you didn't see was the 3 hours I stayed here after you left so I could finish the charts, the phone calls I took/made after hours and the consult I saw this morning before office but didn't ask you to since it was far away from your house". They only see what we let them see.

 

[SouthernSurgeon]

Thats exactly it you see - it is the norm to take advantage of residents.

Society is largely ok with it. Sort of like institutional hazing which gives rise to the "better them than me" mentality.

The sense of a need to disenfranchise residents bf finally letting them be attendings is fiber intrinsic to our culture at large.

You dont want to be hazed? Well then, you cant join our fraternity.

Again a lot of us don't accept the notion that residents are being taken advantage of or hazed.

You're not just getting paid in your salary as a resident. You're getting paid via the training and supervision you're receiving.

I have had some rough times as a resident. Tired. Emotionally exhausted by things like trauma and seeing bad patient outcomes. I have never, ever been "hazed". I've been incredibly well supported by my attendings.

I've learned a thousand times more in these years than I did as a medical student or any other period of my education.

I don't know what the price tag (on our end) of receiving that training should be. But it's a lot. Do we give service back to the hospital in exchange? Absolutely. But I'm pretty sure I came out on the plus side of the equation.

 

[Winged Scapula]

Another idea:

We have more prisons than any other country on earth, by a long stretch. Prisons are a booming industry in the US. Many are empty, newly built waiting to be staffed.

Why dont we build more hospitals instead, and increase the arbitrary resident cap to satisfy needs of all involved.

Its not arbitrary.

What you and most of the students are missing is that the RRC and the individual specialty boards dictate how many cases/patients you have to see.

Are you willing to increase the resident class, only to mean that you scramble for films to read, procedures to do, or to take longer to finish to get those? Believe me, there are programs out there, not just surgical ones, where there are not enough patients for everyone to see and those residents are in trouble. It creates a competitive atmosphere. My residency program spent years trying to get another resident (up from 4 per class to 5) and even through we felt overworked, it took adding several attendings and more cases before we got it approved.

So more residents = fewer pathology slides/radiology films/H&P/ICU management/surgical cases etc per resident.

 

[GadRads]

I've been incredibly well supported by my attendings.

I think this is the key. I don't think the hours worked are that significant when compared to your working environment. Most residents wouldn't mind the long hours if they felt supported by their program, attendings and staff. However an 8 hour work-day in toxic environment may be tantamount to being in jail.

 

[2021Doctor]

Imo the people who justify resident abuse are analogous to the 19th century slaveowners. They attempt to justify total bs.

Here is the crap from the past:
Slavery was good for the slaves; the slaveowners took on the burden of caring for the interests of the slaves, seeing that they would be fed, clothed and given religious instruction

Here is the crap from today:
Working inhumane hours is good for the residents; program directors take on the burden of caring for the interests of these inferior young doctors and decide how they need to be cared for.

 

[ProfMD]

Imo the people who justify resident abuse are analogous to the 19th century slaveowners. They attempt to justify total bs.

Here is the crap from the past:
Slavery was good for the slaves; the slaveowners took on the burden of caring for the interests of the slaves, seeing that they would be fed, clothed and given religious instruction

Here is the crap from today:
Working inhumane hours is good for the residents; program directors take on the burden of caring for the interests of these inferior young doctors and decide how they need to be cared for.

So first it was POW torture, now it's slavery?

Give me a break.

Maybe you should find a new career path where you will be happy.

 

[2021Doctor]

Its not arbitrary.

What you and most of the students are missing is that the RRC and the individual specialty boards dictate how many cases/patients you have to see.

Are you willing to increase the resident class, only to mean that you scramble for films to read, procedures to do, or to take longer to finish to get those? Believe me, there are programs out there, not just surgical ones, where there are not enough patients for everyone to see and those residents are in trouble. It creates a competitive atmosphere. My residency program spent years trying to get another resident (up from 4 per class to 5) and even through we felt overworked, it took adding several attendings and more cases before we got it approved.

So more residents = fewer pathology slides/radiology films/H&P/ICU management/surgical cases etc per resident.

It is arbitrary. The RRCs are made up of slaveholders who decide on rules for the treatment of the slaves. Then when the slaves dare to complain, the slaveholders say "we are just following the rules".
Many RRC rules have been altered to suit the whims of the slaveholders. How many OPEN cholecystectomies is a resident required to perform today vs 1980?

 

[Winged Scapula]

I think this is the key. I don't think the hours worked are that significant when compared to your working environment. Most residents wouldn't mind the long hours if they felt supported by their program, attendings and staff. However an 8 hour work-day in toxic environment may be tantamount to being in jail.

totally agree.

One of the reasons I was fairly miserable as a resident, in addition to the emotional and physical exhaustion was the lack of support from some faculty. Obviously, fortunately there was some support;, the program director, department chair, and other key players did support and help me because otherwise I wouldn't have made it through.

 

[Winged Scapula]

So first it was POW torture, now it's slavery?

Give me a break.

Maybe you should find a new career path where you will be happy.

Even the term hazing belittles the actual experience of military recruits and fraternity or sorority members who do actually experience it.

As I've said before, some people need to get a grip and stop being so histrionic with their terminology.

 

[Crayola227]

Personally, I would be fine with it, though again the logistics would likely be problematic.

As for being an attending, there are no forgiving hours. If you're on service or on call and someone in your family has a medical emergency, one can't just leave. People may not like that, but it's reality.

I don't mean commitment...

I meant more like there are plenty of fields an attending could control the timing of their work week to accommodate a health condition, such as working half time. Working half time to accommodate the fatigue from your MS doesn't mean that you just pack up and leave the minute it hits 5 pm on your last clinic encounter.

 

[ProfMD]

It is arbitrary. The RRCs are made up of slaveholders who decide on rules for the treatment of the slaves. Then when the slaves dare to complain, the slaveholders say "we are just following the rules".
Many RRC rules have been altered to suit the whims of the slaveholders. How many OPEN cholecystectomies is a resident required to perform today vs 1980?

The requirements are not that specific. More like a resident has to perform a certain number of open abdominal cases, open chole being one option. However, the numbers of lap cases have been going up and open going down consistent with changing practice patterns. Residents still need to be familiar with these, though.

But please, tell us more about how we should be training surgical residents.

 

[Light at end of tunnel]

I don't think JK is meaning to belittle anyone or anything here. The obvious analogies are inflammatory by virtue of their very nature.

Nonetheless, the take home point is that simply because something is, doesnt mean it ought to be. Where would we be as a civilization if for example we accepted that certain racial groups were fine as slaves, that woman shouldn't vote, etc?

As a country, we rise to the occasion of changing the status quo because we know it ain't right. Personally, I'm glad we did so that there aren't any slaves, and that woman can vote, among other things.

Perhaps the same can be said for the existing healthcare education system. Maybe in 50 years we will look back, as we do now on MLK and civil rights, and say to ourselves "wow, I cant believe that we were ever OK with that."

 

[2021Doctor]

Even the term hazing belittles the actual experience of military recruits and fraternity or sorority members who do actually experience it.

As I've said before, some people need to get a grip and stop being so histrionic with their terminology.

Sorry, there is no justification for hazing or abuse.
The arguments here amount to justifications that this is only mild abuse or mild hazing so it is okay. Nonsense.

Would you tell a patient it was not so bad if they were only slapped by their abuser instead of being shot or stabbed?

 

[SurfingDoctor]

I don't mean commitment...

I meant more like there are plenty of fields an attending could control the timing of their work week to accommodate a health condition, such as working half time. Working half time to accommodate the fatigue from your MS doesn't mean that you just pack up and leave the minute it hits 5 pm on your last clinic encounter.

Ah. Sure there are part time positions, though that will limit ones practice options. Of course, if that's what makes one happy, it's probably worth the sacrifice in practice options.

 

[username456789]

Imo the people who justify resident abuse are analogous to the 19th century slaveowners. They attempt to justify total bs.

Here is the crap from the past:
Slavery was good for the slaves; the slaveowners took on the burden of caring for the interests of the slaves, seeing that they would be fed, clothed and given religious instruction

Here is the crap from today:
Working inhumane hours is good for the residents; program directors take on the burden of caring for the interests of these inferior young doctors and decide how they need to be cared for.

Jesus Christ please stop.

 

[Light at end of tunnel]

Jesus Christ please stop.

Histrionics all around.

Anyone care for a cigarette?

 

[2021Doctor]

I don't think JK is meaning to belittle anyone or anything here. The obvious analogies are inflammatory by virtue of their very nature.

Nonetheless, the take home point is that simply because something is, doesnt mean it ought to be. Where would we be as a civilization if for example we accepted that certain racial groups were fine as slaves, that woman shouldn't vote, etc?

As a country, we rise to the occasion of changing the status quo because we know it ain't right. Personally, I'm glad we did so that there aren't any slaves, and that woman can vote, among other things.

Perhaps the same can be said for the existing healthcare education system. Maybe in 50 years we will look back, as we do now on MLK and civil rights, and say to ourselves "wow, I cant believe that we were ever OK with that."

Exactly.
Imo the sadistic overtones among some of the posts here is chilling.
Somehow the 600 million plus people in Europe and 35 million people in Canada have no problem seeing that the US resident training system is inhumane and abusive.
The US has often lagged on civil rights and human rights issues compared to many other nations.

 

[ProfMD]

I don't think JK is meaning to belittle anyone or anything here. The obvious analogies are inflammatory by virtue of their very nature.

Nonetheless, the take home point is that simply because something is, doesnt mean it ought to be. Where would we be as a civilization if for example we accepted that certain racial groups were fine as slaves, that woman shouldn't vote, etc?

As a country, we rise to the occasion of changing the status quo because we know it ain't right. Personally, I'm glad we did so that there aren't any slaves, and that woman can vote, among other things.

Perhaps the same can be said for the existing healthcare education system. Maybe in 50 years we will look back, as we do now on MLK and civil rights, and say to ourselves "wow, I cant believe that we were ever OK with that."

Nobody is saying that there cannot be change. We all support the 2003 rules as a positive step for resident education. However, the 2011 changes did not achieve anything. Therefore, we are glad to see them go. As other proposals are put forward, we will be happy to evaluate them.

 

[ProfMD]

Exactly.
Imo the sadistic overtones among some of the posts here is chilling.
Somehow the 600 million plus people in Europe and 35 million people in Canada have no problem seeing that the US resident training system is inhumane and abusive.
The US has often lagged on civil rights and human rights issues compared to many other nations.

The rules you quoted for Canada only apply in Quebec. The rest of Canada has rules that mirror the 2003 ACGME rules. Actually, they are more flexible which makes for better training opportunities.

As for the U.K. system - they train years longer at fewer hours per week and then have trouble finding jobs. No thanks.

 

[SurfingDoctor]

I'm truly curious why people are interested in becoming doctors if they aren't actually interested in training to become doctors? That seems like a unsolvable problem.

 

[2021Doctor]

The rules you quoted for Canada only apply in Quebec. The rest of Canada has rules that mirror the 2003 ACGME rules. Actually, they are more flexible which makes for better training opportunities.

As for the U.K. system - they train years longer at fewer hours per week and then have trouble finding jobs. No thanks.

Imo you are minimizing that which you do agree with.

The current situation of the 48-hour EWTD is as follows.
There are beacons of achievement. Denmark has been compliant with the EWTD for many years and has a normal work week of 37 hours. Sweden and Germany indicate good compliance. Finland is probably compliant. The Netherlands reached compliance during 2011. Norway, which is affiliated with the European Union but is not a full member, trains young doctors in a weekly average of 45 hours. The United Kingdom reports compliance now, but recent research suggests that up to 25% of junior doctors are still working beyond the 48-hour limit.

A small number of administrations, predominantly in northern Europe, have achieved enviable success in reducing duty hours. Restrictions to 48 hours or less have been confirmed to provide safe care for patients while still achieving satisfactory education and training for staff within an acceptable time frame. These goals seem a long way from fulfilment in the rest of the “developed” world at present.

Previously, when training was not subject to any time exposure regulation, the opportunity to learn by the experiential model, with (or often without) adequate supervision, usually produced competent and confident doctors. However, the process of acquiring the necessary skills was largely protracted, osmotic, patron-dependant, and quite variable in quality. With appropriate and graded consultant (specialist) supervision, adequate training can be provided in a 48-hour work week. This demands, first, that this consultant workforce be much more hands-on for 24/7 service delivery as and when the service load demands it and, second, that the service environment “makes every moment count” by viewing any clinical exposure for trainees as having the potential to provide a learning experience.
http://bmcmededuc.biomedcentral.com/articles/10.1186/1472-6920-14-S1-S8

 

[Crayola227]

@SurfingDoctor

I'm bitter because I am of the work ethic and commitment to duty to dig my own grave when ordered to. And I pretty much was, and I pretty much did.
It's a travesty to take the best and brightest and hardest working we can find, and do that. I wasn't the only one.

I cut out a big post where I tell about my life story to say, my only surprise entering the medical field wasn't all the ways I would suffer
It was all the ways my colleagues would hurt me
It was also the way any of us were treated whenever we had human stuff, like cancer, diabetes, arthritis, rape, just to name a few cases *I knew personally*

that were treated.... well? Like Dr. Kelso. You just don't expect that much evil and disdain for human suffering to come from a physician. If it was Wall Street, it would really be less outrageous

I guess a lot of people didn't think training to be a doctor meant being treated without human sympathy, ironically.

TLDR
-I told you my life story to say, I'm not a snowflake
-I'm no stranger and do not object to a lot of stress, discomfort, work, and outright abuse
-I found the psychological atmosphere of training to be pretty damn malignant anyway
-culture of silence, one that punishes those who are hurting and speak up
-culture of toxic shame
-harder on the healthy than necessary, to the point of iatrogenic illness
-self-neglect abounds and is encouraged
-poor treatment & discrimination against the ill within our own ranks
-it's a problem whether you see it or not
-we can do better

I just see the work hour issue as one manifestation of a disease, a blemish in the overall pox affecting the practice of medicine.
It's at best emblematic, at worst just another way they can hurt you more.

 

[schmoob]

Exactly.
Imo the sadistic overtones among some of the post here is chilling.
Somehow the 600 million plus people in Europe and 35 million people in Canada have no problem seeing that the US resident training system is inhumane and abusive.
The US has often lagged on civil rights and human rights issues compared to many other nations.

You lack perspective.
I have had the opportunity to attend military SERE training to get exposure to inhumane and abusive treatment. Feel free to Google the training. What I can tell you is residency is nothing like it, to include the sleep deprivation. Do residents get physically beaten for falling asleep?
Similar to residency for a CHOSEN career path, my training at SERE was voluntary - I do not complain about the treatment I encountered there. So stop spewing your nonsense, you're insulting every POW by comparing their experiences to residency.
If you would like to get political, bring it to the correct forum. That's enough of it here.

 

[2021Doctor]

You lack perspective.
I have had the opportunity to attend military SERE training to get exposure to inhumane and abusive treatment. Feel free to Google the training. What I can tell you is residency is nothing like it, to include the sleep deprivation. Do residents get physically beaten for falling asleep?
Similar to residency for a CHOSEN career path, my training at SERE was voluntary - I do not complain about the treatment I encountered there. So stop spewing your nonsense, you're insulting every POW by comparing their experiences to residency.
If you would like to get political, bring it to the correct forum. That's enough of it here.

Total nonsense imo.
Again, someone says residents are not abused because they are not physically beaten and they are not POWs.
Makes no difference, abuse is abuse.
Lesser degrees of abuse are not any more acceptable than greater degrees of abuse.

 

[ProfMD]

Imo you are minimizing that which you do agree with.

The current situation of the 48-hour EWTD is as follows.
There are beacons of achievement. Denmark has been compliant with the EWTD for many years and has a normal work week of 37 hours. Sweden and Germany indicate good compliance. Finland is probably compliant. The Netherlands reached compliance during 2011. Norway, which is affiliated with the European Union but is not a full member, trains young doctors in a weekly average of 45 hours. The United Kingdom reports compliance now, but recent research suggests that up to 25% of junior doctors are still working beyond the 48-hour limit.

A small number of administrations, predominantly in northern Europe, have achieved enviable success in reducing duty hours. Restrictions to 48 hours or less have been confirmed to provide safe care for patients while still achieving satisfactory education and training for staff within an acceptable time frame. These goals seem a long way from fulfilment in the rest of the “developed” world at present.

Previously, when training was not subject to any time exposure regulation, the opportunity to learn by the experiential model, with (or often without) adequate supervision, usually produced competent and confident doctors. However, the process of acquiring the necessary skills was largely protracted, osmotic, patron-dependant, and quite variable in quality. With appropriate and graded consultant (specialist) supervision, adequate training can be provided in a 48-hour work week. This demands, first, that this consultant workforce be much more hands-on for 24/7 service delivery as and when the service load demands it and, second, that the service environment “makes every moment count” by viewing any clinical exposure for trainees as having the potential to provide a learning experience.
http://bmcmededuc.biomedcentral.com/articles/10.1186/1472-6920-14-S1-S8

I never suggested countries were no compliant. I did say that in order to make up for fewer hours per week, UK residents train for more years. You have yet to address this criticism.

Personally, I am fine with more hours for fewer years. Many others are fine with it too.

 

[LucidSplash]

It is arbitrary. The RRCs are made up of slaveholders who decide on rules for the treatment of the slaves. Then when the slaves dare to complain, the slaveholders say "we are just following the rules".
Many RRC rules have been altered to suit the whims of the slaveholders. How many OPEN cholecystectomies is a resident required to perform today vs 1980?

This shows you'd don't understand general surgery/any surgery training. Open chole falls into a broader case category. Technically you could graduate with zero open choles and have met your requirements with other cases. I wouldn't recommend it because there are still patients out there who end up needing an open chole, but it is possible. The requirements are not static and are reviewed every few years. For example, starting with those graduating 2018, the requirement for complex laparoscopic cases increases to 75, which is a decent sized increase. This reflects the shift in standard of care over the years with more cases being done laparoscopically.

 

[2021Doctor]

I never suggested countries were no compliant. I did say that in order to make up for fewer hours per week, UK residents train for more years. You have yet to address this criticism.

Personally, I am fine with more hours for fewer years. Many others are fine with it too.

I never addressed this critcism because I do not think it is valid.
In Europe medicine is generally a five to six year undergraduate degree.
In the USA it is generally an eight year process (four for undergrad and four for med school).
So any slight increases in postgraduate training is offset by the shorter amount of time in school
http://journalofethics.ama-assn.org/2012/12/medu1-1212.html

Currently doctors in the UK may train for up to 16 years before qualifying. 5 years for their degree (or six if you intercalate and take a useful subject like, say, History of Medicine), 2 years for a post-graduate foundation course, and then 3 to 8 years in specialist training.
https://www.theguardian.com/science...aining-how-long-does-it-take-to-make-a-doctor

Gaining specialisation in a certain area of medicine is an integral part of medical specialist training in Germany. Training programmes can take five to six years and are conducted at university medical centres or other facilities which are authorised to provide specialist training.
https://www.study-in.de/en/plan-you...edicine/medical-specialist-training_35929.php

 

[Light at end of tunnel]

@jkdoctor - please take heed, you are very close to being banned or having your account held for what will be described to you as various violations of TOS all in an effort to quiet you down

We all hear you loud and clear, but you need to settle down

just to be clear, this is my own opinion based on this threads very palpable pulse - no moderator or admin has discussed anything in this regard; I didn't mean to imply I had any authority to ban him or anyone else, but I apologize if I gave that impression

 

[2021Doctor]

This shows you'd don't understand general surgery/any surgery training. Open chole falls into a broader case category. Technically you could graduate with zero open choles and have met your requirements with other cases. I wouldn't recommend it because there are still patients out there who end up needing an open chole, but it is possible. The requirements are not static and are reviewed every few years. For example, starting with those graduating 2018, the requirement for complex laparoscopic cases increases to 75, which is a decent sized increase. This reflects the shift in standard of care over the years with more cases being done laparoscopically.

No. Actually I do understand. The ARBITRARY requirements were charged.
You said "Technically you could graduate with zero open choles".
That would never have been allowed 20 years ago.
Here is a nice look at some changes in case numbers over time:
http://jamanetwork.com/journals/jamasurgery/fullarticle/390594

 

[LucidSplash]

No. Actually I do understand. The ARBITRARY requirements were charged.
You said "Technically you could graduate with zero open choles".
That would never have been allowed 20 years ago.
Here is a nice look at some changes in case numbers over time:
http://jamanetwork.com/journals/jamasurgery/fullarticle/390594

Again, no, the requirements aren't arbitrary. There doesn't need to be a specific category for cholecystectomy of any kind because it is far and away the most common general surgery case. No one is graduating without enough gall bladder experience. Your citation is a 17-year-old article that is just descriptive of changing volumes over time. As category requirements are frequently reassessed with changes such as this in mind, it actually supports the fact that this isn't arbitrary. Thank you for providing a citation which supports my position rather than yours.

 

[2021Doctor]

@jkdoctor - please take heed, you are very close to being banned or having your account held for what will be described to you as various violations of TOS all in an effort to quiet you down

We all hear you loud and clear, but you need to settle down

Ok. Thanks. I will sign off on the thread.

 

[SurfingDoctor]

@SurfingDoctor

I'm bitter because I am of the work ethic and commitment to duty to dig my own grave when ordered to. And I pretty much was, and I pretty much did.
It's a travesty to take the best and brightest and hardest working we can find, and do that. I wasn't the only one.

I cut out a big post where I tell about my life story to say, my only surprise entering the medical field wasn't all the ways I would suffer
It was all the ways my colleagues would hurt me
It was also the way any of us were treated whenever we had human stuff, like cancer, diabetes, arthritis, rape, just to name a few cases *I knew personally*

that were treated.... well? Like Dr. Kelso. You just don't expect that much evil and disdain for human suffering to come from a physician. If it was Wall Street, it would really be less outrageous

I guess a lot of people didn't think training to be a doctor meant being treated without human sympathy, ironically.

TLDR
-I told you my life story to say, I'm not a snowflake
-I'm no stranger and do not object to a lot of stress, discomfort, work, and outright abuse
-I found the psychological atmosphere of training to be pretty damn malignant anyway
-culture of silence, one that punishes those who are hurting and speak up
-culture of toxic shame
-harder on the healthy than necessary, to the point of iatrogenic illness
-self-neglect abounds and is encouraged
-poor treatment & discrimination against the ill within our own ranks
-it's a problem whether you see it or not
-we can do better

I just see the work hour issue as one manifestation of a disease, a blemish in the overall pox affecting the practice of medicine.
It's at best emblematic, at worst just another way they can hurt you more.

Well your particular situation does sound bad, but that doesn't mean it is universal (nor can I see how working 16 hours as an intern would have beneficial effect overall to the issues you mention). I would also say that being dissatisfied with ones peers is not unique to medicine or any particular field... it comes in all walks of life. Either one learns to rise above it or one let's it eat at them... though sometimes that's easier said than done.

 

[ProfMD]

I never addressed this critcism because I do not think it is valid.
In Europe medicine is generally a five to six year undergraduate degree.
In the USA it is generally an eight year process (four for undergrad and four for med school).
So any slight increases in postgraduate training is offset by the shorter amount of time in school
http://journalofethics.ama-assn.org/2012/12/medu1-1212.html

Currently doctors in the UK may train for up to 16 years before qualifying. 5 years for their degree (or six if you intercalate and take a useful subject like, say, History of Medicine), 2 years for a post-graduate foundation course, and then 3 to 8 years in specialist training.
https://www.theguardian.com/science...aining-how-long-does-it-take-to-make-a-doctor

Gaining specialisation in a certain area of medicine is an integral part of medical specialist training in Germany. Training programmes can take five to six years and are conducted at university medical centres or other facilities which are authorised to provide specialist training.
https://www.study-in.de/en/plan-you...edicine/medical-specialist-training_35929.php

In that case, you would have to revamp US undergraduate medical education as well. So, it is relevant if you are trying to apply the European experience to the US.

 

[Light at end of tunnel]

JK backed off, let's everyone back off of them.

This thread has flown off the reservation. Let's get it back on track. Good lord.

 

[nlax30]

Long thread here and have only just glanced at a few of the pages...

Honestly I think I'm fine with this change. I know when my program went to the current hour/shift limitations it did cause scheduling issues as we were a small IM program and had to get creative with coverage. Ultimately for some fields I don't think it's a critical change one way or the other, though I definitely see the concerns in fields such as surgery where it could impact time in the OR.

I guess I'm a little more sensitive to potential changes now that I'm going into a 2nd fellowship that 2 years ago just got increased to two years due to increasing complexity of the procedures and numbers needed, so while this doesn't really effect me, if say they decided to make other shift or weekly hour restrictions that then made it harder for me to get my numbers in two years, or required an increase to three years then I would be very disappointed.

 

[xffan624]

I will comment that the topic came up on the Pediatrics interview trail a couple of times this year and most programs stated they didn't really foresee any changes in their scheduling of residents based on it.

 

[MediCane2006]

Yep. And as stated multiple other times: for many (most?) of us those of us that have done both (I was an intern in 2010-2011 and did 28-hour shifts and then switched to night float for junior residents in 2011), night float is way worse. Yes I am a surgery resident so I can only speak for surgery, and only at my institution, but I have heard from friends elsewhere in my specialty that they feel the same.

Being tired isn't fun but you know what? There are worse situations to be in. I'm inside, I'm warm, I can sit down in a chair sometimes to do my work, my socks are dry, I'm fed: I'm not in the military or other job out in the elements pulling long shifts or in an actual sweatshop. And on average I get a hell of a lot more respect than some of those people. I get that the idea of working an overnight shift sounds daunting to those of you who haven't actually done it, but there are those that HAVE who are telling you that 28 hours and going home to sleep/read/grocery shop postcall is far superior to being isolated on night float for a month at a time with a totally jacked up sleep schedule. Talk about losing your sanity. Those were the only months of residency that I honestly thought about quitting every day.

I'm only on page 2 but this is the best damn post in the thread.

 

[MediCane2006]

Or some people just value their health, livelihood, and families. I don't mind working 80 hour weeks, I've done it before and I knew that was the game when I decided to switch careers -- but if you presented me with a choice I'd be willing to do a residency twice as long while working half the hours.

Ummm.....NO.

(as someone who was a PGY-10 last year, I would prefer to not spend basically my entire prime working years in training, thank you)