Medical Schools' Response

[spiderman719]

Below are a series of letters and press releases from AAMC President Dr. Jordan J. Cohen. In them, the AAMC, which respresents medical colleges, responds to outside pressure to reduce resident works hours. Their basic premise: the situation is improving and we are dealing with the problem with our own internal checks and balances (ACGME accreditation, etc).

I'm curious how many medical students/residents agree with their position.

May 9, 2002: <a href="http://www.aamc.org/newsroom/pressrel/2002/020509.htm" target="_blank">AAMC Responds to Resident Lawsuit</a>

January 4, 2002: <a href="http://www.aamc.org/advocacy/library/educ/corres/2002/010402.htm" target="_blank">Letter to Rep. Conyers on "Patient and Physician Safety and Protection Act" </a>

November 1, 2001: <a href="http://www.aamc.org/newsroom/pressrel/2001/011101.htm" target="_blank">AAMC Approves New Policies for Graduate Medical Education</a>

February 9, 2000: <a href="http://www.aamc.org/newsroom/pressrel/2000/000209.htm" target="_blank">AAMC President Cohen Criticizes NLRB Ruling in New England Journal of Medicine Editorial</a>

November 30, 1999: <a href="http://www.aamc.org/newsroom/pressrel/1999/991130.htm" target="_blank">AAMC Statement on NLRB Boston Medical Center Ruling by Jordan J. Cohen, M.D., President, AAMC</a>

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[Ryo-Ohki]

My twisted views:

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AAMC Responds to Resident Lawsuit:
America has a great medical training system. We can place every medical school graduate into a hospital, therefore the current system is the best. We will challenge anyone who thinks otherwise.

Letter to Rep. Conyers on "Patient and Physician Safety and Protection Act"
You dumb ass politicians don't know jack about our medical system. We are more then qualified to handle our own affairs. And.....we care about our residents! Really, we do!

AAMC Approves New Policies for Graduate Medical Education:
Well, there was enough pressure on us that we had to change some of our policies. By the way, you guys are still students; not employees (so we do not have to treat you with the same respect as we treat our employees)

AAMC President Cohen Criticizes NLRB Ruling in New England Journal of Medicine Editorial:
NLRB, why the hell are you sticking your noses in our business? These residents are our slav....err..students. We can't help it if residents are idiots and don't know their own rights of appeal. In any case, allowing residents to unionize is wrong, because it would hurt us.

AAMC Statement on NLRB Boston Medical Center Ruling:
NLRB, you guys are so idiotic. You have no idea how much you guys hurt our pocket books. Residents shouldn't be allowed to strike because they are students! You little pissants aren't qualified to understand our complex medical education process. We're the AAMC, damn it!

 

[TheThroat]

I am only commenting on the response to the lawsuit.

I for one love the match for a number of reasons.
1. I only had to send in one application. It would be much more difficult to send in THIRTY different applications.
2. I knew that I was being offered the same salary as my colleagues. It would be VERY weird if I knew that another intern made significantly more or less than I did for the same work.
3. I didn't have to worry about different programs calling me back with offers at different times. Being forced to pick between programs with the question of "should I choose this job or should I wait for a better one?" would be awful. I applied, interviewed, and then ranked the programs based on where I would like to go. When I matched, I knew that I was accepted to the highest choice that had a spot open for me (my 2nd choice by the way).

 

[Ryo-Ohki]

Yeah, it's awful when you have choices, huh? It makes my head hurt &gt;_&lt;

 

[spiderman719]

Ryo: Your responses crack me up!!! <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" />

Throat: You make some good points regarding the benefits of the match.

However, those positives are NOT necessarily specific to a matching program.

•••quote:••• 1. I only had to send in one application. It would be much more difficult to send in THIRTY different applications.
••••Well, for SFMatch the matching and application are more mixed, but for the main match, ERAS (centralized application) and NRMP (centralized match) are completely separate. We could easily do away with the NRMP and keep ERAS. (or the application part of SFMatch, which I think is better because it's a paper app instead of an electronic one).

•••quote:••• 2. I knew that I was being offered the same salary as my colleagues. It would be VERY weird if I knew that another intern made significantly more or less than I did for the same work. ••••Good point, but one that's dealt with at most companies and organizations. In fact, once we all finish our residencies, we will almost certainly be paid different salaries from our colleagues. This may be a point of contention, but at many companies the salaries are kept confidential.

•••quote:•••3. I didn't have to worry about different programs calling me back with offers at different times. Being forced to pick between programs with the question of "should I choose this job or should I wait for a better one?" would be awful. I applied, interviewed, and then ranked the programs based on where I would like to go. When I matched, I knew that I was accepted to the highest choice that had a spot open for me (my 2nd choice by the way).
••••So you are referring to the so-called "Time-Bomb" job offers that explode before you can make a decision on another job. This kind of tactic could be avoided (if need be), by setting a date--before which applicants can hold as many residency offers as they want, and after which they have a finite amount of time to decide, similar to med school admissions (don't mean to bring back bad memories for anyone!!) :wink:

 

[Stormreaver]

•••quote:•••Originally posted by spiderman719:
•So you are referring to the so-called "Time-Bomb" job offers that explode before you can make a decision on another job. This kind of tactic could be avoided (if need be), by setting a date--before which applicants can hold as many residency offers as they want, and after which they have a finite amount of time to decide, similar to med school admissions (don't mean to bring back bad memories for anyone!!) :wink: •••••As an IMG, I was offered out-of-Match positions, and they were indeed time-linked, "Sign with us now/in 24 hours/within the week or we won't consider you." THOSE are to be worried about, and that is one thing the Match does prevent. Your idea is indeed a good one and something like it should be used to prevent this kind of arm-twisting.

 

[Hamster]

First let me thank you spiderman719 for bringing this to our attention. I really do wish more intellectual discussions concerning the future of our chosen profession would take place on this forum... But I guess I am a nerd.

I am just an MS1, so I feel I can't give an informed opinon on the work conditions of residents but I felt compelled to respond to one argument I found fault with in the February 9,2000 article....

•••quote:••• Dr. Cohen writes, "Residents are not powerless. They may be unaware of their power, or of how to exercise it, but residents do have the power to improve the conditions under which they learn. They need to know that the ACGME requires all institutional sponsors of GME programs to establish formal procedures whereby housestaff can register their complaints, grievances, and/or recommendations." The ACGME strengthened its call for effective representation of residents' viewpoints as recently as September 1998, when it adopted a new set of institutional requirements. ••••Because I have personally experienced trying to exercise "the power" bestowed upon students by an institutional administration - I know first hand that no such power exists. It seems as a student or even as a large group of students... one can only make reccomendations for change, but not guarantee that a change will be made no matter what the neccessity. So, IMHO when you are tied by a conflict of interest ( cheap labor) AND apathy ( hey I don't have q1 call, but you do so deal with it) there needs to be a better system in place to give residents the oppurtunity to make an immediate change. I.. I can only imagine how powerless residents are in reality.

I am one who likes to decide based on both sides of the argument...but I did not really see the 'other side' give specific reasons why unionization will not work. Saying "It is bad, believe me I know" is not enough.

•••quote:••• Dr. Cohen writes, "Doctors seeking marketplace leverage though unions are trading their precious ethic of professionalism for commercialism's promise of a quick fix. Residents need to be fully acquainted with the perils inherent in that Faustian tradeoff."
••••Yeah.... Ok so threatening to withhold a hospitals source of happiness ( cheap labor=$$$$) maybe a low blow...but when you don't have a chair to stand on you hit anything within reach. Like I said earlier, I am certain that if the current procedures were 'enough' then residents would not be taking such drastic measures.

Well I must go,

 

[spiderman719]

Hamster,

Great post...Although residents at many programs are able to change their working conditions somewhat, there is an expectation of what they can and can't expect--i.e. they can change the logistics of their call schedule, but they still have to cover all the hours.

On another point: Does anyone know what a "Faustian tradeoff" is?

 

[AMSA LAD]

HI Folks,

I am AMSA's Legislative Affairs Director and as such have a large amount of information cocnerning the medical community's response to work hour issues, etc...

It is true that the AAMC reformulated their work hours policy this past fall. It is also true that this was a direct result of increasing federal pressure. They now support all the regulations proposed in the Conyer's work hours bill. The 80 hour weekly limit, the 24 hour limit for on call shifts, q3 call, etc...

What the AAMC conveniently left out of their "new" policy statement was reference to the fact they have supported an 80 hour work week limit since 1988!! (Journal of Medical Education, Volume 63, May 1988...the JME is the predecessor to Academic Medicine) Yes, that's right, since 1988, the AAMC has supported an 80 hour work week limit for residents and yet has done virtually nothing to advocate for the implementation of this policy. Its very nice that the AAMC still believes in an 80 hour weekly limit. I have no doubt they will go another 13 years without actually advocating for it. In additoin, the AAMC has not proposed any real means of internal enforcement of said rules, hence the need for government oversight, either state or federal.

 

[TheThroat]

Hamster,

Just wanted to clarify that, at some institutions, residents do have power. Here at Uiowa, the interns petitioned that CT surgery be changed from q2 to q3 call. The letter specifically mentioned the RRC's guidelines reguarding q2 call. One month later, the call was changed fomr q2 to q3, and the CT fellows covered the other call nights! I agree that residents work long hours and often are working without receiving a medical education, but the system is changing, abeit slowly.

 

[CoffeeCat]

•••quote:•••Originally posted by spiderman719:
•On another point: Does anyone know what a "Faustian tradeoff" is? •••••It means trading your soul for something that you want very badly. Faust was a play by Goethe

<a href="http://www.awerty.com/faust.html" target="_blank">Faust</a>

 

[NuMD97]

I beg to differ about the salary base of interns. I recall that some programs, depending on location (midwest and southwest, I believe), would still offer a PGY-1 "stipend" in the range of $34,000.00. Whereas most programs in NY offer PGY-1 interns close to (if not actually, depending on the program) $40,000.00. A $6,000.00 differential is substantial to me, but not enough to make a final decision based on salary alone. Just thought I'd throw that into the mix here.

 

[Stormreaver]

Nu is right: my PGY salary is close to $35,000. Having said that, cost of living is low so I'd still end up saving more than my friend who's earning $38K in Boston or $40K in NYC.

 

[spiderman719]

•••quote:•••Originally posted by CoffeeCat:
•It means trading your soul for something that you want very badly. Faust was a play by Goethe

<a href="http://www.awerty.com/faust.html" target="_blank">Faust</a>•••••Thanks, CoffeeCat!!!