New work hour regulations???

[Celiac Plexus]

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if you cant handle an 80 hour work week dont go into surgery
its the wrong field for you
i hope it stays the way it is

Interesting... when I was a medical student the residents worked 120 hour weeks. Now 80 hours is viewed as a high work burden. One day someone will post on this site: "If you can't handle a 50 hour work week, don't go into surgery".

I think the emphasis on work hours is really missing the point. Residency should be about education, period. Limiting a work week to 80 hours is a joke. If we could somehow measure resident achievement, and operative proficiency is a reliable way, I would wager that some programs that adhere tot he 80 hour work week would have better trained residents than some that work 100 hours per week. We need to identify new training techniques/models that can turn out well-trained surgeons within the defined work hours whatever they may be.

 

[TrabNY]

http://img149.imageshack.us/my.php?image=img00047yo4.jpg

here is a pic I took at the ACS conference in New Orleans. the speaker said that the hours will be like Europe in 5 years. The consequences for future trainees is crazy (increased number of years, less exposure, less cases ect...)

Oh my God!! The speaker at this conference was most likely a fraud, or the janitor...
France 35 hours... Half right... Yeah, if you are working at the post office, or if you are a middle class clerk!
But doesn't apply in any field of private practice and in the hospital (public and private)...

It's like me saying that every single American is a God freak and an obese!!
I truly would like to know the name of the guy who did this conference!!

 

[opr8n]

the 80h workweek has caused me to miss ALOT of educational opportunities

i cant even imagine if it was cut even further
i dont know if i would feel competant after 5 years to be a general surgeon

and i worry about the future of general surgery putting out graduates that worked only 60h/w as residents over 5 years

based on my experiences they will have missed alot

 

[GSresident]

I dont think we can adopt a european model. Residents provide much needed cover for hospitals. You just can't leave the hospital without cover. Also, training time will be eternal, and I hope they remember many of us students have huge debts and a need to work.

I have no idea what will happen with work hours in this country and I don't really give a hoot. I pose a question - why is it the resident's job to "provide much needed cover" for the hospital? I thought residency was supposed to be about education. Can't you people see that you are being used as indentured servants ? You little lambs are being sacrificed so that the hospital CEO can have a beach house in Key West and drive an S class instead of a Taurus.

 

[opr8n]

I have no idea what will happen with work hours in this country and I don't really give a hoot. I pose a question - why is it the resident's job to "provide much needed cover" for the hospital? I thought residency was supposed to be about education. Can't you people see that you are being used as indentured servants ? You little lambs are being sacrificed so that the hospital CEO can have a beach house in Key West and drive an S class instead of a Taurus.

this is sooo true and its sad

residents have become the "cover" for the hospital in alot of places, where their true purpose is not learning

 

[GSresident]

this is sooo true and its sad

residents have become the "cover" for the hospital in alot of places, where their true purpose is not learning

I can't wait until my former residency program asks me for money. Really I can't. When I get that letter I am going to send them a bill.

When I was a second year they pulled the CTS resident off the CTS service and put him/her out at a VA. In order to replace that one resident they had to hire 4 PA's at $120K per year. That is the real value of a resident to a hospital. I didn't mind working for less than $480K a year in residency because I figured I was also getting an education at the same time, but seriously people. I was paid $34950 that year. Where did the extra $445050 go? What college charges $445050 a year for tuition and makes you work 80-120 hours a week or more? Maybe they could have thrown a couple bucks my way to go to a meeting or to have bought a few books. Maybe they could have at least gotten us good health insurance that didn't bargain out certain procedures so that if you really do have a health problem it would be covered. Maybe they could have not charged us $500 a month out of pocket for that garbage health insurance. I'm not giving them a freaking penny. I gave at the office thank you.

You guys currently in general surgery training better pull your collective heads out of your butts and get over the whole 'I'm a macho surgeon' crap. Just because I used to be forced to work 120 hours a week doesn't mean that it was right or that you should have to. I'm probably not any smarter or better technically for having spent the extra 40 hours in the hospital filling out paper work and 'providing cover' for the hospital.

 

[SomedaySoon]

I think the emphasis on work hours is really missing the point. Residency should be about education, period. Limiting a work week to 80 hours is a joke. If we could somehow measure resident achievement, and operative proficiency is a reliable way, I would wager that some programs that adhere tot he 80 hour work week would have better trained residents than some that work 100 hours per week. We need to identify new training techniques/models that can turn out well-trained surgeons within the defined work hours whatever they may be.

Well said. The old adage, "quality not quantity."

Before the work hour restircitons, the attitutude was to do everything for your patients and your education, and leave when you were done. Now the attitude seems to be to do as much work as you can fit into 80hrs and then leave, and if you finish your work before 80 hrs, do something else to fill up 80hrs. At least at my program, where the 80hr restriction is called the "80hr requirement" and it is unheard of to work less, even if you didn't have anything real to do, because leaving early would be "lazy."

This National Institutes of Medicine research/recommendation for new duty hour restrictions isn't just about total work hours- it also aims to restrict continuous work hours, I think to 16hrs. No more overnight call! All night float and shifts. Discuss amongst yourselves.

 

[GSresident]

Before the work hour restircitons, the attitutude was to do everything for your patients and your education, and leave when you were done. Now the attitude seems to be to do as much work as you can fit into 80hrs and then leave, and if you finish your work before 80 hrs, do something else to fill up 80hrs.

I really like taking care of my patients. Notice the emphasis there. When I was a resident we could easily handle the services patient load of legitimate patients and I enjoyed taking care of them. What really pissed me off was that not only were we taking care of 'our patients' but every other service in the hospital dropped trou and took a big crap on us every single day. Here are a few examples:

Page at 2:30 AM from Ortho Intern - "Hey we just got out of the OR with a 14 hour spine case. Come write admission orders and do an admission H&P."

Page at 2:35 AM from ENT Intern - "We just finished a radical neck and cancer whack on this dude. He has no IV access and the nurses are too busy to try. Come put a central line in him oh and by the way we don't manage vents so admit the patient to your service and take care of him, NOW."

Page at 2:37 AM from the psych resident in the ER - "There is this schizophrenic guy who is high on PCP, crack, meth, pot and has a blood alcohol of 480. He also has a 1cm lac to his scalp where the cops clubbed him. Come sew up the lac and admit him to your service, since he has a lac and all."

This goes on all night. The next morning at 9:15AM the page comes in from the GI fellow "Hey we got this guy in clinic with Hep C and esophageal varices. We finna scope him and do a transplant workup. Come do an H&P, write admission orders and by the way take all the calls on the patient. We don't have a service."

And the best part: Radiology decided that they would no longer read non-emergent films in the middle of the night. Every time an NG tube got placed or a central line got placed by any service anywhere in the hospital the policy was to call the general surgery resident to read the films and confirm placement. I would respond to these pages by saying "are you trying to reach radiology?" I eventually gave up trying to argue the point and just went and read the damn films.

So I went out to the VA as the vascular chief and used the whole "I don't have a service" line. It worked for a while and then I got the big anal probe for it.

 

[Winged Scapula]

Woot! GSResident is on a roll!

Doesn't this want to make you reconsider general surgery instead of PRS?

 

[GSresident]

Woot! GSResident is on a roll!

Doesn't this want to make you reconsider general surgery instead of PRS?

Yeah I'm sorry. I don't know what my problem is today. I must have had a nightmare about general surgery again last night. I'm getting better but the wounds of that residency still hurt almost 2 years later. General surgery residency stomped all humanity out of me and I became a monster. Slowly, very slowly, I am losing my fangs and claws and dropping my scales. I hope I can someday turn back into a human at least half as good as I was before I entered residency.

I really feel sorry for the guys and gals stuck in general surgery. I know what you are going through. I want to help you change it into a better field but in order for that to happen you have to see that it needs to change. I don't have much hope for you though. It seems that every day new suckers enter the field and the 'I'm a macho surgeon I can take all the punishment and more' attitude is alive and well. It doesn't have to be that way.

 

[SocialistMD]

Page at 2:30 AM from Ortho Intern - "Hey we just got out of the OR with a 14 hour spine case. Come write admission orders and do an admission H&P."

Page at 2:35 AM from ENT Intern - "We just finished a radical neck and cancer whack on this dude. He has no IV access and the nurses are too busy to try. Come put a central line in him oh and by the way we don't manage vents so admit the patient to your service and take care of him, NOW."

Page at 2:37 AM from the psych resident in the ER - "There is this schizophrenic guy who is high on PCP, crack, meth, pot and has a blood alcohol of 480. He also has a 1cm lac to his scalp where the cops clubbed him. Come sew up the lac and admit him to your service, since he has a lac and all."

This kind of gets to something else that bothers me. While I have never had other surgical specialties call me to write their admission notes, I have had many consultants call me to tell me what to do. I notice it happens more at our children's hospital, where we get the consults of "You need to put a line in this kiddo today" and "you need to do a Nissen on this kiddo." There is a lack of professional courtesy when you are told you "need" to do something rather than being consulted about a particular disease and being asked for your help and expertise.

 

[ExtraCrispy]

This kind of gets to something else that bothers me. While I have never had other surgical specialties call me to write their admission notes, I have had many consultants call me to tell me what to do. I notice it happens more at our children's hospital, where we get the consults of "You need to put a line in this kiddo today" and "you need to do a Nissen on this kiddo." There is a lack of professional courtesy when you are told you "need" to do something rather than being consulted about a particular disease and being asked for your help and expertise.

I agree 100%. It's perhaps my biggest pet peeve (although 2 am consults about routine matters that the caller "forgot" to pursue during daylight hoursare a pretty close second). I call it the "pizza delivery" phenomenon.

"Hi, I'd like a large pepperoni with cheese, and an I&D on this woman's leg."

"Um...an I&D isn't appropriate in this patient."

"But, you have to do it, I ORDERED it! Oh, and throw in an extra large soda."

This happens all the time, particularly with inappropriate trach & peg consults. They treat us like technicians. When I reply that the procedure they're "ordering" isn't appropriate, they act put off.

"But we've consulted you to do this."

"Ok, are you going to take responsibility when this patient suffers a complication from a procedure he shouldn't have had in the first place? Will you be liable?"

Silence. "But Dermatology says you should do it."

Sadly, I'm not making this up.

 

[Winged Scapula]

My Fav from Peds Med Onc (this happened more times than I can count):

2 am page: Hi, its Med Onc. We have this kiddo who has to start chemo tomorrow so you have to put a port in him. First thing in the morning would be fine.

Me: How long has the kid been in the hospital? When was he diagnosed?

Med Onc: some gibberish about it being days but there being excuses about why they didn't call until now which really means they forgot and realized that the kid didn't have a port and chemo was scheduled to start in the am, so lets call the port jockeys to put it in at THEIR convenience.

You'd think after several rounds of this they would figure out that the ORs were not at their disposal nor the OR staff and surgeons.🙄

 

[supercut]

I can't wait until my former residency program asks me for money. Really I can't. When I get that letter I am going to send them a bill.

When I was a second year they pulled the CTS resident off the CTS service and put him/her out at a VA. In order to replace that one resident they had to hire 4 PA's at $120K per year. That is the real value of a resident to a hospital. I didn't mind working for less than $480K a year in residency because I figured I was also getting an education at the same time, but seriously people. I was paid $34950 that year. Where did the extra $445050 go? What college charges $445050 a year for tuition and makes you work 80-120 hours a week or more? Maybe they could have thrown a couple bucks my way to go to a meeting or to have bought a few books. Maybe they could have at least gotten us good health insurance that didn't bargain out certain procedures so that if you really do have a health problem it would be covered. Maybe they could have not charged us $500 a month out of pocket for that garbage health insurance. I'm not giving them a freaking penny. I gave at the office thank you.

Not to mention that the hosptial gets paid > $100K/year per resident by medicare to "fund resident education". They don't get this subsidy to hire PA'sl.

 

[McCracken]

They BILL 120 hours, which as we all know, is not the same as actually working 120 hours!

Remember the law code of ethics:
Article 1.01: "One shall bill in 1 hour increments for every 15 minutes of actual work."
Article 1.02: The end.

Bit backwards there. You need to work 3 hours to bill 1. 15 mins is 1/4 an hour. But trust me, my partner's a lawyer, he's at work 100 hours/week and barely bills 40.

Be nice to the lawyers, they help us out when we really screw up.

 

[Smurfette]

Ug! I HATE those 2 am "you need to put a port in this patient tomorrow" consults. Or G-tube. Or trach. WTF? But what bothers me even more is when the attending accommodates it and bumps scheduled cases, one of which inevitably gets cancelled due to OR delays and lack of staffing after hours.

One of the places we rotate at is notorious for abusing the on-call surgery resident, who is often the only person in-house. So urgent surgery consult in the middle of the night with orders for "surgery resident to do admission orders"...on a patient with a consult for "PEG" or "port". Or surgical subspecialists telling clerks to call surgery resident to do their consults since they don't want to come in (I've been TOLD that attending GU attg said I am to deal with the non-surgical patient who ripped out their foley and is bleeding profusely...not just a trickle, the patient was bleeding into a basin with a steady stream...from his urethra and to deal with complicated recurrent nosebleeds not controlled by packing by an ENT attg who was snuggled in his bed and didn't want to come in but figured I could "temporize" the patient for a few hours until he got there....as if I don't have my own patients to deal with). Sorry folks, but if the PGY-3 surgery resident walks in the room, and thinks that the subspecialty attending needs to get there because the patient needs them/the OR NOW and not in 8 hours, the nurse and clerk should not refuse to call said attending back because he said "call surgery resident to deal with it".

But truthfully, as long as other residents find certain things as ridiculous as I do, at least I feel vindicated somewhat. You get a bit toxic for a while, and then it goes away for a while, etc. Residency is just a big roller coaster...

 

[GSresident]

Ug! I HATE those 2 am "you need to put a port in this patient tomorrow" consults. Or G-tube. Or trach. WTF? But what bothers me even more is when the attending accommodates it and bumps scheduled cases, one of which inevitably gets cancelled due to OR delays and lack of staffing after hours.

The common element in all these situations is that there was a resident involved. That is why the consult for an elective procedure came at 2AM. A culture gets into the hospital/nurses that you can make any demand, no matter how ridiculous, at any hour and it will be accommodated, and if it isn't get out the pen for a write up. I am seeking out hospitals that don't have and have never had residents for that very reason. The bit about your attending is the worst part because fulfilling unreasonable demands only encourages more.

The worst part about my general surgery residency was that our staff never backed us up if there was a problem or dispute. If anyone complained about a surgery resident the surgery resident was always wrong period. I learned that pretty early on. I was an intern and we were in the trauma bay. There was a GSW to the chest that came in talking to the trauma bay and lost consciousness and vitals. The chief and 3rd year went over to the left side of the chest but the clerk was in the way putting a wrist band on the patient. The chief said "hey we gotta get in here." The clerk responded in a snotty voice "I'm putting on the wrist band. This is a team approach." So the chief says "Get the hell out of the way NOW!"

They cracked the chest, clamped the artery and the patient lived. 2 days later we had M&M. The patient was presented not as an extraordinary save but because the clerk wrote the surgery resident up. We got an hour long lecture about how you need to be professional at all times and how every member of the team is just as important as the next. WTF!?!? That is just one stupid example. Things like that, maybe not quite as egregious with a life involved, went on every single day. I dare those pompous A-holes to ask me for money. I DARE them.

 

[skiz knot]

But trust me, my partner's a lawyer, he's at work 100 hours/week and barely bills 40.

...your partner's partnering with someone else.

 

[VoiceofReason]

I am officially scared of a general surgery residency.

 

[Blade28]

We have this kiddo who has to start chemo tomorrow so you have to put a port in him. First thing in the morning would be fine.

Hey, all the Peds guys talk like that here too! "We have this kiddo..."

What's that great saying that's applicable here?

Poor planning on your part does not constitute an emergency on my part.

 

[Faebinder]

Ug! I HATE those 2 am "you need to put a port in this patient tomorrow" consults. Or G-tube. Or trach. WTF? But what bothers me even more is when the attending accommodates it and bumps scheduled cases, one of which inevitably gets cancelled due to OR delays and lack of staffing after hours.

One of the places we rotate at is notorious for abusing the on-call surgery resident, who is often the only person in-house. So urgent surgery consult in the middle of the night with orders for "surgery resident to do admission orders"...on a patient with a consult for "PEG" or "port". Or surgical subspecialists telling clerks to call surgery resident to do their consults since they don't want to come in (I've been TOLD that attending GU attg said I am to deal with the non-surgical patient who ripped out their foley and is bleeding profusely...not just a trickle, the patient was bleeding into a basin with a steady stream...from his urethra and to deal with complicated recurrent nosebleeds not controlled by packing by an ENT attg who was snuggled in his bed and didn't want to come in but figured I could "temporize" the patient for a few hours until he got there....as if I don't have my own patients to deal with). Sorry folks, but if the PGY-3 surgery resident walks in the room, and thinks that the subspecialty attending needs to get there because the patient needs them/the OR NOW and not in 8 hours, the nurse and clerk should not refuse to call said attending back because he said "call surgery resident to deal with it".

But truthfully, as long as other residents find certain things as ridiculous as I do, at least I feel vindicated somewhat. You get a bit toxic for a while, and then it goes away for a while, etc. Residency is just a big roller coaster...

I can't even begin to express how mad the bolded part makes me. It happens to me way too much. It happens when the attending is a dinosaur... old school mentality.. work work work work... efficiency doesn't matter. As if the world hasnt changed since those days. How fair is it to the people waiting a month to get in? In academia, there is no in and out cases... everything takes forever.

 

[surgiwho]

Bit backwards there. You need to work 3 hours to bill 1. 15 mins is 1/4 an hour. But trust me, my partner's a lawyer, he's at work 100 hours/week and barely bills 40.

Be nice to the lawyers, they help us out when we really screw up.

I don't know where your partner works, but from experience, and I have unfortunately had plenty of it (indirectly and directly), I have never seen this to be the case. I have gotten plenty of bills as follows:

-Drive to court: 1 hour (their office is 15 min away, and they have cases all day, so therefore they bill the same 1 hour to their 10 clients that day)
-Phone call: 30 min x 9 (they left a message or never happened)
-Review case: 1 hour (you would be surprised how many times they review the same case!)
-I can go on and on at the bogus charges they bill...

Imagine if we could bill like that:
Waiting for OR to be ready: 30 min
Drive to Hospital: 30 min
Patient calls: 1 hour
$hit, I would be happy if we could bill PATIENT VISITS after a procedure!!!!

Maybe I just have bad luck, or maybe you just need a gift of god to find a lawyer that doesn't charge this way. Like I said, from experience this is what I have seen!

And, I am nice to them, until they screw me and everyone I know.

Feel free to PM your partner's info!

Sorry didn't want to hijack the thread

 

[Winged Scapula]

Hey, all the Peds guys talk like that here too! "We have this kiddo..."

Yeah, I had never heard it myself but our Peds surgeons say that too. Must have rubbed off on them (and then onto me).

What's that great saying that's applicable here?

Poor planning on your part does not constitute an emergency on my part.

Exactly. If I had been coherent enough to think of that it would have been the perfect response EXCEPT that the attendings never backed us up. Oh they would complain about it and say it wasn't right, but they would always manage to get the case on so the middle of the night "stat" consults for ports continued.😡

I'm beginning to think GSResident and I went to the same program! At least it wasn't Smurfette's program...those consults sound ridiculous!

 

[surgiwho]

This kind of gets to something else that bothers me. While I have never had other surgical specialties call me to write their admission notes, I have had many consultants call me to tell me what to do. I notice it happens more at our children's hospital, where we get the consults of "You need to put a line in this kiddo today" and "you need to do a Nissen on this kiddo." There is a lack of professional courtesy when you are told you "need" to do something rather than being consulted about a particular disease and being asked for your help and expertise.

This is something that I experienced A LOT on Peds Surg. For some reason Pediatricians love to do this all the time. I really don't know why. Maybe it's b/c Peds Surgeons were very accomodating and didn't really tell them what they should have, they were very passive-aggressive. The problem is that they never got the sarcasm of their dumb a$$ demands.

Once, a pediatrician complained to the peds surgeons about me. She wanted us to take a pt. back to the OR, because days after surgery, he had diarrhea! My response was:

"Great, plumbing is working!!!

 

[DrDawg]

"You need to put a line in this kiddo today"

Get this one a lot. Typically the call comes while the child is eating breakfast. Awesome

 

[Blade28]

I'm beginning to think GSResident and I went to the same program! At least it wasn't Smurfette's program...those consults sound ridiculous!

Don't get me started on my ridiculous consults. One of the worst was a consult to "remove Steri-Strips."

I kid you not.

 

[TrabNY]

Well, I don't know if you noticed, but the annoying attendings, the one always asking us to do the most stupid things at night, are often the one biking with a helmet on... I know, it sounds weird, but think of the personality of this people... Yeah, I'm serious... Attendings that are so scared of everything. "Hi, I was just going to bed, and I thought, maybe madam X need a central line... you know... just in case, blah blah blah....".... This is happening way too often... And I won't even talk of ER doc... (not all of them are crappy, far from it!!! But some of them.... Damn it...)...
That's my 2 cents!!

 

[Winged Scapula]

Don't get me started on my ridiculous consults. One of the worst was a consult to "remove Steri-Strips."

I kid you not.

That's pretty bad.

The worst one I can recall was a "stat" wound evaluation for a patient on psych.

I arrive to find the patient with a very dirty and presumably old dressing on his wrist. It was taped down pretty well so fairly obvious no one had taken the dressing down and actually looked at the "wound".

I did.

My cat makes scratches deeper than this guy had on his wrists. Abrasions would be overstating the case.

I signed off.

 

[OTD]

I got a classic "stat consult" from the psych service today.

To avoid cross posting it is the last post in the Call Stories section of the Intern forum.

It just makes you want to bang your head into a wall.

 

[GoodMonkey]

Don't get me started on my ridiculous consults. One of the worst was a consult to "remove Steri-Strips."

I kid you not.

omg, so terrible. yet, so funny.

 

[SocialistMD]

Don't get me started on my ridiculous consults. One of the worst was a consult to "remove Steri-Strips."

I kid you not.

I had one where I saw a patient with a clogged J-tube. I told them to flush it with cola first, then with pancreatic enzymes if that didn't work. I wrote the order myself (in detail), explained how to do it in my note and told the nurse and intern covering how it should be done. Not fifteen minutes after leaving the floor did I get a call from the senior resident asking me if I could come do it. I explained that (a) I was in the OR and (b) typically the nurses take care of it, but it would be done exactly the same as how the patient's feeds would normally be put in, except that you would leave it sit in the tube on purpose. Her reply was that neither the nurse nor anyone on the team felt comfortable doing it. 🙄

 

[surgicalskills]

As a PGY-2 general surgery resident I have strongly disagree with people here who are so against work hour regulations. We are being abused by the system. Why can't you people get this? It is because of this mentality that administrators continue to get away with abuse of residents. We have situations in our hospital where the nursing administration has completely overshadowed all the residency departments, constantly writing up even chief residents for simply doing their jobs. Just last week, due to nursing error, a trach was dislodged, and patient could not be bagged through the trach. Fiberoptic intubation had to be initiated. Nursing supervisor and president tried to muddy the waters with claiming that surgery was late to the scene, and the chief resident began damage control instead of fighting these ****ing bastards.

I don't know how surgery was before but I hear people had some power in this profession. Now, it seems as if our balls have been cut off, yet some people here still try to perpetuate that fake macho mentality, "Yeah, if you're not working 100 hours a week, then, you ain't learning enough." Why work 1980's work hours when we are not being treated like the way 1980's physicians used to be treated. For new breed of surgeons to still think like that is truly bizarre.

Major portion of my time everyday is social work, paperwork, being slave to all other services and just plain being a secretary. That's not surgery. I could be spending that time reading. I'm way behind reading right now because I'm way over 80 hours a week.

Make these damn hospitals hire PA's. They can afford it, believe me. Some of the salaries to these administrators are outrageous. What the hell do they do? We can work 80 hours easy and significantly improve our education by actually concentrating on surgery itself. Get on the bandwagon people, change your mentality. Five years of this **** is more than enough to be a competent surgeon.

 

[gerickson03m]

As a PGY-2 general surgery resident I have strongly disagree with people here who are so against work hour regulations. We are being abused by the system. Why can't you people get this? It is because of this mentality that administrators continue to get away with abuse of residents. We have situations in our hospital where the nursing administration has completely overshadowed all the residency departments, constantly writing up even chief residents for simply doing their jobs. Just last week, due to nursing error, a trach was dislodged, and patient could not be bagged through the trach. Fiberoptic intubation had to be initiated. Nursing supervisor and president tried to muddy the waters with claiming that surgery was late to the scene, and the chief resident began damage control instead of fighting these ****ing bastards.

I don't know how surgery was before but I hear people had some power in this profession. Now, it seems as if our balls have been cut off, yet some people here still try to perpetuate that fake macho mentality, "Yeah, if you're not working 100 hours a week, then, you ain't learning enough." Why work 1980's work hours when we are not being treated like the way 1980's physicians used to be treated. For new breed of surgeons to still think like that is truly bizarre.

Major portion of my time everyday is social work, paperwork, being slave to all other services and just plain being a secretary. That's not surgery. I could be spending that time reading. I'm way behind reading right now because I'm way over 80 hours a week.

Make these damn hospitals hire PA's. They can afford it, believe me. Some of the salaries to these administrators are outrageous. What the hell do they do? We can work 80 hours easy and significantly improve our education by actually concentrating on surgery itself. Get on the bandwagon people, change your mentality. Five years of this **** is more than enough to be a competent surgeon.

Good post. I agree. But in some programs there is the 80 hour limit but you still have the same amount of paperwork which can be crazy.

 

[Blade28]

I had one where I saw a patient with a clogged J-tube. I told them to flush it with cola first, then with pancreatic enzymes if that didn't work. I wrote the order myself (in detail), explained how to do it in my note and told the nurse and intern covering how it should be done. Not fifteen minutes after leaving the floor did I get a call from the senior resident asking me if I could come do it. I explained that (a) I was in the OR and (b) typically the nurses take care of it, but it would be done exactly the same as how the patient's feeds would normally be put in, except that you would leave it sit in the tube on purpose. Her reply was that neither the nurse nor anyone on the team felt comfortable doing it. 🙄

I've had to unclog G-tubes/J-tubes more times that I can count. I've recommended/tried everything, too: saline, water, air, Coke, Diet Coke and pancreatic enzymes.

 

[Amgen1]

As a PGY-2 general surgery resident I have strongly disagree with people here who are so against work hour regulations. We are being abused by the system. Why can't you people get this? It is because of this mentality that administrators continue to get away with abuse of residents. We have situations in our hospital where the nursing administration has completely overshadowed all the residency departments, constantly writing up even chief residents for simply doing their jobs. Just last week, due to nursing error, a trach was dislodged, and patient could not be bagged through the trach. Fiberoptic intubation had to be initiated. Nursing supervisor and president tried to muddy the waters with claiming that surgery was late to the scene, and the chief resident began damage control instead of fighting these ****ing bastards.

I don't know how surgery was before but I hear people had some power in this profession. Now, it seems as if our balls have been cut off, yet some people here still try to perpetuate that fake macho mentality, "Yeah, if you're not working 100 hours a week, then, you ain't learning enough." Why work 1980's work hours when we are not being treated like the way 1980's physicians used to be treated. For new breed of surgeons to still think like that is truly bizarre.

Major portion of my time everyday is social work, paperwork, being slave to all other services and just plain being a secretary. That's not surgery. I could be spending that time reading. I'm way behind reading right now because I'm way over 80 hours a week.

Make these damn hospitals hire PA's. They can afford it, believe me. Some of the salaries to these administrators are outrageous. What the hell do they do? We can work 80 hours easy and significantly improve our education by actually concentrating on surgery itself. Get on the bandwagon people, change your mentality. Five years of this **** is more than enough to be a competent surgeon.

keep a few things in mind

first, as you climb up the tree there will be less and less paper work that you spend your time doing. as a junior resident you get crap dumped on you. as a pgy3, 4, etc you will not be spending much time doing paper work. you will be spending time operating

second, studies have shown that with the 80 hr work week regulations people have not increased their reading. absite scores have not improved. it is a fallacy that working less will increase your studying. dec work hours results in more time sleeping, going out to dinner, etc

third, there is a critical mass of operations/time required to become proficient in surgery. the more time you cut away, the more you are going to affect this

 

[surgicalskills]

keep a few things in mind

first, as you climb up the tree there will be less and less paper work that you spend your time doing. as a junior resident you get crap dumped on you. as a pgy3, 4, etc you will not be spending much time doing paper work. you will be spending time operating

second, studies have shown that with the 80 hr work week regulations people have not increased their reading. absite scores have not improved. it is a fallacy that working less will increase your studying. dec work hours results in more time sleeping, going out to dinner, etc

third, there is a critical mass of operations/time required to become proficient in surgery. the more time you cut away, the more you are going to affect this

Okay, you're right, more time in OR, means more proficiency. However, skills continue to improve dramatically with becoming an atteding and level of confidence continues to improve. So, the question is, is the 80 hour work week sufficient enough to make a surgeon ready for real world practice. I think it is. We'll continue to improve regardless.

My point regarding decreased work hours has nothing to do with study time, board scores, etc. I only mentioned that I think I can better utilize the extra time spend on bull**** stuff at work and one of those things being studying. If I can get a few hours a week extra for my self due to decreased work hours, I should be able to do what ever the hell I want with it. It doesn't have to be reading.

Regarding your point with less grunt work with seniority, I say this: So what. Does that mean that lower ranking residents still has to be abused. and, anyway, it's not about that. It's about getting rid of this whole mentality that residents can be exploited by hospitals anyway they please.

The climate in medical profession has changed. Physicians face a very challenging future and we have to adapt. the whole industry has to adapt. In order for us to level the playing field, we have to create an enviornment that is more suitable for us. If I'm going to get paid less for more work, more paperwork, less respect, less power, then, I want to work less and let the hospital do its own secreterial work. Let them hire some damn PA's.

 

[surgicalskills]

Good post. I agree. But in some programs there is the 80 hour limit but you still have the same amount of paperwork which can be crazy.

fine. Answer to that: PAs. Residents are to be trained to be physicians / surgeons, not secretaries, not social work. That should be an amendment in some sort of medical constitution.

 

[Winged Scapula]

fine. Answer to that: PAs. Residents are to be trained to be physicians / surgeons, not secretaries, not social work. That should be an amendment in some sort of medical constitution.

Hmmm..and what do you plan on doing when you are an attending and faced with a mountain of paperwork that HAS to be done by you?

There are certain things I cannot pass off to my office manager or MA, nor a PA.

I agree that residency needs to be a time of training and education and there is too much non-educational stuff going on, but frankly, some of the stuff is useful and you will continue to do during the rest of your career.

 

[DrDawg]

I had one where I saw a patient with a clogged J-tube. I told them to flush it with cola first, then with pancreatic enzymes if that didn't work. I wrote the order myself (in detail), explained how to do it in my note and told the nurse and intern covering how it should be done. Not fifteen minutes after leaving the floor did I get a call from the senior resident asking me if I could come do it. I explained that (a) I was in the OR and (b) typically the nurses take care of it, but it would be done exactly the same as how the patient's feeds would normally be put in, except that you would leave it sit in the tube on purpose. Her reply was that neither the nurse nor anyone on the team felt comfortable doing it. 🙄

The hospital is a very uncomfortable place these days. Sometimes I feel that we are the only ones comfortable doing anything. example

Recent Line consult from medical icu at 2 am
MICU resident: Can you come place an CVL for us? We want an IJ
Me: Your MICU, can't you do that?
MICU: I'm not signed off.
Me: Call you senior in to help you, or place a femoral now, and then an IJ when they come in this AM.
MICU: They wont come in, and we'r not comfortable with femorals
Me (inner voice): guess your f****d

 

[Southpaw]

second, studies have shown that with the 80 hr work week regulations people have not increased their reading. absite scores have not improved. it is a fallacy that working less will increase your studying. dec work hours results in more time sleeping, going out to dinner, etc

Regardless of a study, it doesn't seem like much of a stretch for me to believe that if I'm working less, I'm studying more. It's been personal experience for me during my 3rd year, and before, that the more free time I have the more time I spend studying. Sure, some study proves me wrong, but I still know myself. Regardless, whether or not I study with my free time doesn't equate to not wanting free time.

I found surgicalskills post quite accurate with respect to the fact that mentality in surgery doesn't seem to have changed much since the good ole' days, but many things around it have. In some ways that's a good thing, but as surgicalskills stated, in many others ways it's quite a bad thing. It sickens me that nurses can obviate their duties by blaming something on the surgeon. It sickens me even more that the surgeon didn't take a flamethrower to someone. But hey, that's just me. 🙂

 

[toxic-megacolon]

fine. Answer to that: PAs. Residents are to be trained to be physicians / surgeons, not secretaries, not social work. That should be an amendment in some sort of medical constitution.

For me, and I think I speak for most non-interns in General Surgery I don't go over hours because of paperwork, but rather being on call every third night, and attendings that decide to schedule elective cases at 3 or 4pm that go late into the evening...

 

[JKP]

general surgery days are over...

fragmented into sub-specialties...

GI people will be doing lap choles man!

 

[Blade28]

For me, and I think I speak for most non-interns in General Surgery I don't go over hours because of paperwork, but rather being on call every third night, and attendings that decide to schedule elective cases at 3 or 4pm that go late into the evening...

Agreed.

 

[Faebinder]

Agreed.

I hate electives added... its like your time is not valued.

 

[Amgen1]

However, skills continue to improve dramatically with becoming an atteding and level of confidence continues to improve. So, the question is, is the 80 hour work week sufficient enough to make a surgeon ready for real world practice. I think it is. We'll continue to improve regardless.

I think this is a fallacy. Most surgical residents are hitting their strides when they are chief residents. Your skills are pretty much established by the time you are a chief. You are doing major cases and you are operating all day, everyday. People who are excellent surgeons were excellent chiefs. people who are crappy surgeons were crappy as chiefs.

Regarding your point with less grunt work with seniority, I say this: So what. Does that mean that lower ranking residents still has to be abused. and, anyway, it's not about that. It's about getting rid of this whole mentality that residents can be exploited by hospitals anyway they please.

My point is that by the time your are an upper level resident you are still in the hospital 80+ hrs per wk, but that time is being spent operating and making clinical decisions. That is the time that is valuable we don't want cut into. As an intern, it is not going to affect your education if you have to work 60hrs instead of 80. As a 3rd, 4th, 5th yr it is going to affect your education to work 60hrs instead of 80

 

[ORS]

"The common element in all these situations is that there was a resident involved. That is why the consult for an elective procedure came at 2AM. A culture gets into the hospital/nurses that you can make any demand, no matter how ridiculous, at any hour and it will be accommodated, and if it isn't get out the pen for a write up. I am seeking out hospitals that don't have and have never had residents for that very reason. The bit about your attending is the worst part because fulfilling unreasonable demands only encourages more."

The nurse culture should and needs to be changed. They should not be calling us at all hours of the night for matters that can wait till the morning. I have received calls to sign a medicine reconciliation form, remove staples, sign prescriptions.....

My solution is to say. "Your threshold for calling me should be the same as calling an attending at home, if it is not important enough for that then do not call me till 5AM"

 

[Blade28]

My solution is to say. "Your threshold for calling me should be the same as calling an attending at home, if it is not important enough for that then do not call me till 5AM"

Unfortunately that's not how it is. And as long as there are people in-house, other hospital staff will always feel like you're there to be paged anytime.

 

[sleeping]

I am officially scared of a general surgery residency.

As Yoda said, "You will be,....You will be"

 

[RichL025]

The hospital is a very uncomfortable place these days. Sometimes I feel that we are the only ones comfortable doing anything. example

Recent Line consult from medical icu at 2 am
MICU resident: Can you come place an CVL for us? We want an IJ
Me: Your MICU, can't you do that?
MICU: I'm not signed off.
Me: Call you senior in to help you, or place a femoral now, and then an IJ when they come in this AM.
MICU: They wont come in, and we'r not comfortable with femorals
Me (inner voice): guess your f****d

That happened to me the other day with a trauma mid-workup in the ED, and half a dozen other consults stacked up.

My reply was NO, I will NOT come and do the line for you. But either call in your attending to supervise you, or I will be happy to supervise you while YOU do the procedure (and you better have everything ready and be ready to stick before you call me). I guess they called in their attending because I never heard from them again.

(I _did_ make sure the patient was not exsanguinating or anything, first)

 

[Celiac Plexus]

I really like taking care of my patients. Notice the emphasis there. When I was a resident we could easily handle the services patient load of legitimate patients and I enjoyed taking care of them. What really pissed me off was that not only were we taking care of 'our patients' but every other service in the hospital dropped trou and took a big crap on us every single day. Here are a few examples:

Page at 2:30 AM from Ortho Intern - "Hey we just got out of the OR with a 14 hour spine case. Come write admission orders and do an admission H&P."

Page at 2:35 AM from ENT Intern - "We just finished a radical neck and cancer whack on this dude. He has no IV access and the nurses are too busy to try. Come put a central line in him oh and by the way we don't manage vents so admit the patient to your service and take care of him, NOW."

Page at 2:37 AM from the psych resident in the ER - "There is this schizophrenic guy who is high on PCP, crack, meth, pot and has a blood alcohol of 480. He also has a 1cm lac to his scalp where the cops clubbed him. Come sew up the lac and admit him to your service, since he has a lac and all."

This goes on all night. The next morning at 9:15AM the page comes in from the GI fellow "Hey we got this guy in clinic with Hep C and esophageal varices. We finna scope him and do a transplant workup. Come do an H&P, write admission orders and by the way take all the calls on the patient. We don't have a service."

And the best part: Radiology decided that they would no longer read non-emergent films in the middle of the night. Every time an NG tube got placed or a central line got placed by any service anywhere in the hospital the policy was to call the general surgery resident to read the films and confirm placement. I would respond to these pages by saying "are you trying to reach radiology?" I eventually gave up trying to argue the point and just went and read the damn films.

So I went out to the VA as the vascular chief and used the whole "I don't have a service" line. It worked for a while and then I got the big anal probe for it.

Or interventional radiology admitting patients on to your service so that you can manage the fibrinogen, and ptt levels... sweet.

Or the ob/gyn consults for central lines.... "um, no I can't get consent for you to do the line because we are only allowed to consent for procedures we do.".... um okay... and then after getting all of the crap together to do the line on the floor, and getting a consent signed off, the transport guy arrives to take the patient to IR to have a PICC line placed... when I called the ob/gyn resident about this I was told "oh yeah, well I consulted you (surgery) and IR at the same time to see who could put the line in fastest..." wha tha fuuuu....?