Well, since you obviously haven't been to my home institution I find it ironic that you're GUARANTEEING how much my residents work. They do not, in fact, work 24 hour shifts. They are there 6 DAYS a week. They do not work overnight unless they are on trauma.
I had this long post typed...and then SDN lost it. <sigh>
- How do they "not work 24 hour shifts," but yet still work overnight?
- Even if they work 6 days a week, there is still the question of who covers the hospital at night when nightfloat gets their mandatory day/days off. Unless you're trying to say that they're on-call every weekend...in which case they ARE working 24 hour shifts.... You're not making much sense.
Or else you're saying that nightfloat is on for 7 nights a week....in which case I wouldn't say that too publically, as that is a clear violation of work-hours.
- Actually, now that I think about it, IM at many large institutions would not be affected AT ALL. Since most IM programs went to a combination of short call and night float, IM residents rarely (if ever) work more than 24 hours in a row. In fact, most IM residents tend to cap out at 16 hours in a row, so they wouldn't be affected by the new regulations at all.
Even the smaller community programs could adjust their resident work hours fairly easily. What would probably end up happening is that the on-call resident would take a "break" in the mid-afternoon, and then come back on duty a few hours later. That way, since they haven't worked 16 hours in a row, they'd be "exempt" from the required 5-hour sleeping break. It'd be a little awkward, but it would be doable.
So I do not buy your argument that surgery would be equally affected as other specialties. Other specialties can adapt more easily than surgery or OB could.
And the senior resident actually slept for a good 5 hours every night.
Yeah, the senior residents
But under the new regulations, the senior residents would sleep less
, because they'd have to help cover while the junior residents get their required 5 hours of sleep. The IOM report openly admits that senior/chief residents and fellows would most likely have to pick up the slack for those five hours. While it might be nice as a junior resident, you'll probably hate it when you're a chief!
What I see surgery residents doing most is pushing stretchers to radiology, and drawing blood. I think they can hire someone else to do that.
That has less to do with the ACGME regulations, and more with the nature of your region. It's a separate issue, in my opinion.
I would be willing to bet that you did your surgery rotation in NYC, which is a widely known exception. NYC nurses are heavily unionized, and through these unions have managed to excuse their nurses from tasks such as drawing blood, doing EKGs, and pushing stretchers. That has less to do with resident regulations, and more with the nursing unions in that particular area of the country.
This doesn't happen that often, even in hospitals just a couple of hours north or south.
If central lines and chest tubes need to be placed emergently, the overworked and un-rested surgical resident is not the only one who can do that. Every single specialty which has overnight call (including Psych to some extent) is expected to be proficient at emergent procedures and ACLS. In fact, any hospital based speciality... Emergency Med, IM (which is where hospitalists come from), Critical Care... needs to be more proficient at these procedures than your garden variety surgeon, who only consults and operates. Your observation that surgical residents have more of these procedures to log doesnt pan out.
You're ignoring the issue of territory/politics.
Surgical patients get trached by surgeons - i.e. someone from either the primary team or from the SICU (which is staffed by surgeons). It's a question of responsibility for YOUR patient, which YOUR team is taking care of....i.e. not coming in on rounds one morning and being like, "What random ER resident decided to intubate Mr. Jones?!??!"
It's the same reason why, generally, if you didn't put a JP drain in, then you don't d/c it. You don't know why the primary team put the JP in, when they did, how long it's supposed to be in there for, what it's draining, etc....so you do not touch it.
You're not the primary team, so you don't have a lot of input as to the patient's plan.