New ACGME Standards

[G0S2]

http://acgme-2010standards.org/


16hrs max for pgy-1

"Strategic napping" after 10p.

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[urge]

That's pretty sweet.

Pity I had to do over 32hrs straight when I was an intern.

 

[secretasianman]

That's pretty sweet.

Pity I had to do over 32hrs straight when I was an intern.

what's the likelihood that this will be implemented.. seriously? 16hour shifts for pgy1s? ;p

 

[JackADeli]

what's the likelihood that this will be implemented.. seriously? 16hour shifts for pgy1s? ;p

I suspect it is a pretty good likelihood a significant component will be implemented.

 

[G-Man82]

I don't see how much of this will affect an Anesthesiology resident anyway. When I interviewed, all residents went home after 24 hours. I guess, the "single patient" rule allows CA residents to stay on in the middle of a large case? And the 14 hours off after a 24-hour shift: don't programs give you the entire post-call day off anyway? Does the change to supervision have any implications for the Anesthesiology resident?

I start my intern year next week; I would have liked 16 hours rather than overnights on my upcoming ICU months.

 

[Narcotized]

.

 

[Fastrach]

If this sticks it to any one specialty in particular, it's likely IM, and frankly they deserve everything they get. To all the beaten-down Anesthesia interns who had to serve as slaves on the medicine wards, taking extra call because of the IM residents' clinic days, admitting their 10th gorked-out gomer of the night from the nursing home at 5 AM in the ER... your day of justice has arrived.

 

[cchoukal]

The consequence (intended or not) that rarely gets discussed in conjunction with such regulation is that "work" may be left undone. That is, there is a quantifiable, ever-expanding, amount of work that must be done. If you're going to reduce work hours, you need to do one of the following:

1) Reduce the work to be done. Wouldn't it be great if you could get rid of al the BS aspects of being a trainee? Too bad no one can define what is and is not important for your training. They can always claim that discharge planning and patient transport are part of the "systems-based practice."

2) Hire other people to do the uneducational stuff (see point #1 above). And the obvious solution here is to hire mid-levels. But guess what? An NP or PA brought into handle the BS parts of resident work doesn't want to limit themselves to paperwork and scut (can you blame them?). So eventually they are dissatisfied too.

3) You make the resident work more efficiently. Please.

I don't want this to sound like a rant, or a tirade against mid-levels, but while the ACGME pretends to be protecting residents during their training, they may be selling the future of medicine down the river by creating policies that necessitate the hiring of non-physician providers to do what has historically been "physician" work. The natural extension of this is to reconsider what is "physician" work, the next natural extension of which is lobbying by non-physicians to expand their autonomy and scope of practice. And who can blame THEM when we've gone and trained them to do our job under the guise of compliance with work-hour restrictions.

 

[Ronin2258]

If this sticks it to any one specialty in particular, it's likely IM, and frankly they deserve everything they get. To all the beaten-down Anesthesia interns who had to serve as slaves on the medicine wards, taking extra call because of the IM residents' clinic days, admitting their 10th gorked-out gomer of the night from the nursing home at 5 AM in the ER... your day of justice has arrived.

My experience has been that IM beats people unnecessarily in training as well. I saw it doing a surgery prelim as well, when my fellow IM residents were beaten and were in the hospital forever. The surgery group actually *gasp* went home at reasonable hours. Transistionals would take electives with us to get a break from medicine floors (how is that for a twist of things?)

I don't want this to sound like a rant, or a tirade against mid-levels, but while the ACGME pretends to be protecting residents during their training, they may be selling the future of medicine down the river by creating policies that necessitate the hiring of non-physician providers to do what has historically been "physician" work. The natural extension of this is to reconsider what is "physician" work, the next natural extension of which is lobbying by non-physicians to expand their autonomy and scope of practice. And who can blame THEM when we've gone and trained them to do our job under the guise of compliance with work-hour restrictions.

There are some places that do that already. WHC in DC when I rotated there a few years back had the 8 resident teams and the midlevels team. The learning cases went to the resident teams. Midlevels handled the gomers, and more brain-numbing admits. Never saw things like DKA, gomers, or COPD exacerbations admitted to the resident teams (well, almost never.) There seemed to be a fire sale on AML and blast crises, though.

I can see where the scenario you described can happen.

 

[Laryngophed]

The consequence (intended or not) that rarely gets discussed in conjunction with such regulation is that "work" may be left undone. That is, there is a quantifiable, ever-expanding, amount of work that must be done. If you're going to reduce work hours, you need to do one of the following:

1) Reduce the work to be done. Wouldn't it be great if you could get rid of al the BS aspects of being a trainee? Too bad no one can define what is and is not important for your training. They can always claim that discharge planning and patient transport are part of the "systems-based practice."

2) Hire other people to do the uneducational stuff (see point #1 above). And the obvious solution here is to hire mid-levels. But guess what? An NP or PA brought into handle the BS parts of resident work doesn't want to limit themselves to paperwork and scut (can you blame them?). So eventually they are dissatisfied too.

3) You make the resident work more efficiently. Please.

I don't want this to sound like a rant, or a tirade against mid-levels, but while the ACGME pretends to be protecting residents during their training, they may be selling the future of medicine down the river by creating policies that necessitate the hiring of non-physician providers to do what has historically been "physician" work. The natural extension of this is to reconsider what is "physician" work, the next natural extension of which is lobbying by non-physicians to expand their autonomy and scope of practice. And who can blame THEM when we've gone and trained them to do our job under the guise of compliance with work-hour restrictions.

I think there is one more option and that would be to expand the number of residents you bring on. Year for year, a resident is cheaper (particularly when one considers all of the additional overhead a regular employee (the midlevels) generates as compared to the bastard child of education and work that residents are) and can be made to work more, allowing for more of all of the BS to get done.

 

[Laryngophed]

Increase the number of anesthesiologists produced and you can guess what will happen next...

Moar sleepy people?

 

[cchoukal]

I think there is one more option and that would be to expand the number of residents you bring on. Year for year, a resident is cheaper (particularly when one considers all of the additional overhead a regular employee (the midlevels) generates as compared to the bastard child of education and work that residents are) and can be made to work more, allowing for more of all of the BS to get done.

The various boards would never allow this. It will increase the number of physicians with whom they'll be competing for jobs. The market would never support the number of attendings that would result from hiring the number of residents required to staff every hospital with a training program.

 

[Ronin2258]

If memory serves, a large intern class is not what they are looking for.

There were in olden times (and people older than I can refute me if they want,) but residencies were like a pyramid scheme, with more senior levels with fewer positions than junior levels. So the entire year was a battle to get those ever decreasing seats. High backstab factor in that, of course.

If they increase only the intern numbers (i.e. prelim med, surg, and transitional,) instead of across all PGY years, at the end of the year, a lot of them will be out of a residency, and not able to practice effectively, as most places require people to be board eligible/board certifiable. This isn't the old days where you could go out after intern year and be at least a reasonable doctor. I think those days have gone by the wayside.

 

[Masseter Spasm]

While these guidelines may appear to "improve" the residency training process, I am concerned that the guidelines may ultimately undermine the value of residency training.
Many on this board have commented on the "differences" in training between midlevel providers and physicians. There have also been many comments about the "shift-work" mentality of midlevels. (Must go home at 3:30, abandon patient in PACU, etc...)
While residency training involves a fair amount of BS, scut work, etc., it ultimately prepares you to be a real doctor. Structuring resident work hours too aggressively may reduce the quality of training that "separates" us from midlevels. It may also blur the distinctly different responsibilities between physician and midlevel.

 

[Jeep23Guy]

what's the likelihood that this will be implemented.. seriously? 16hour shifts for pgy1s? ;p

Our GME director (an anesthesiologist) was on the committee at the ACGME that came up with the guidelines and she told us that these rules will go into effect in 2011, but may be postponed until 2012. There is something like a 45 day period for programs to comment on the changes.

Too little, too late for me...starting intern year in 5 days.