# of GS Applicants in the 2003 Match

[Voxel]

Drum roll please....

As of October 10th, 2002.

2002 US Applicants: 980
2003 US Applicants: 1131

The level of interest in general surgery seems to have increased this year.

Caveat there are about 500 more US Applicants in the match this year as compared to last year.

There are also ~1100 more US applicants who have applied to atleast 1 program (any residency program).

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[jth9]

Thanks for that info. I'd like to know where you got the info so I can read more about it.

I had suspicions the numbers would rise this year. My guess? I think it's because people who otherwise wouldn't consider surgery in the past due to competitiveness, are now applying. Also, the idea that there will be a shortage of surgeons in the future is probably another factor. Anything else?

 

[dkwyler94]

I'm curious of where these numbers are from. I am interested in General Surgery, but am not at the top of my class (not at the bottom either), so I have been watching the numbers. I do anticipate the numbers shifting back towards more applicants in General surgery.

The numbers I have I got from a scutwork.com link. It indicates the following:

2019 offered positions in 2002 NRMP Match
469 unfilled positions.

2053 offered positions in 2001 NRMP Match
511 unfilled positions.

 

[droliver]

The overwhelming # of those "unfilled" positions were preliminary spots which are lumped into that #. I think the number of categorical (or normal tract positions) spots unfilled was somewhere b/w 30-40. This again, represents a very small % of all the positions available but the trend for more unfilled positions starting in 1998+ is what has so many worried with the decreasing # of students interested & the older/more female population of todays med schools (both of which groups are less likely to pursue surgical careers).

 

[drusso]

Originally posted by droliver
...is what has so many worried with the decreasing # of students interested & the older/more female population of todays med schools (both of which groups are less likely to pursue surgical careers).

Interesting. Why would older and female populations in general be less likely to enjoy surgery?

 

[Skylizard]

Originally posted by drusso
Interesting. Why would older and female populations in general be less likely to enjoy surgery?

I don't think it is a matter of enjoyment. Some of the issues are as follows.

1. Older med-students (those I have talked with) are less likely to tolerate being abused by a 28-30 year old chief. Older med-students are less willing to take 5-7 years before they can start paying off loans and/or earning money. Older med students often go into med-school somewhat secure with the knowledge of what and where they want to practice. Older med-students will often apply in a limited geographic region due to community, family, and professional ties. As I said in the beginning, this is based on my conversations with older med-students and not on some survey or large study.

2. Women often have family issues to consider. This could be mariage, this could be child-bearing, this could be child rearing, or caring for other family members. There is a prejudicial statement I hear stated often about women surgeons, "there is no such thing as a normal female surgeon". I find this statement offensive. Having said that, many women for good reason are unwilling to jump into the surgical frying pan with the deck already stacked against them!

Aside from points 1 & 2, federal assessment of the surgical workforce projects a shortage in surgeons directly related to the increasing numbers of females in surgery. A female surgeon is likely to work less hours and less total years. From my point of view, I attribute this to women having more balanced lifes and having other priorities that their male counterparts should probably learn.

Again, I do not think it is an enjoyment issue. I do not believe anyone enjoys the abuse associated with training in any program and I do not believe anyone enjoys missing the hollidays with their families. Having said that, almost universally, everyone I spoke to enjoys the anatomy and excite associated with most surgery.

Later

 

[drusso]

Originally posted by Skylizard
I don't think it is a matter of enjoyment. Some of the issues are as follows.

1. Older med-students (those I have talked with) are less likely to tolerate being abused by a 28-30 year old chief.

Why not just implement a zero tolerance policy on older student/female student abuse? I bet you if a chief knew that being abussive meant risking 5 years of surgical training going down the tubes, the rates of abuse would drop dramatically. The US Armed Forces instituted a similar policy toward female recruits and its been very successful. I think its really about just finding the right incentives to motivate behavior change. I doubt that surgical chiefs are born abusive in nature...they're probably just come to be that way.

Originally posted by Skylizard
2. Women often have family issues to consider. This could be mariage, this could be child-bearing, this could be child rearing, or caring for other family members. There is a prejudicial statement I hear stated often about women surgeons, "there is no such thing as a normal female surgeon".

I was speaking to a female medical student from Canada about a similar issue. The Canadian resident education system is far more generous with maternity/paternity leave and child care issues. Why not simply offer high quality child care options for female (and male) residents with young children?

Originally posted by Skylizard
Aside from points 1 & 2, federal assessment of the surgical workforce projects a shortage in surgeons directly related to the increasing numbers of females in surgery. A female surgeon is likely to work less hours and less total years. From my point of view, I attribute this to women having more balanced lifes and having other priorities that their male counterparts should probably learn.

Again, I do not think it is an enjoyment issue. I do not believe anyone enjoys the abuse associated with training in any program and I do not believe anyone enjoys missing the hollidays with their families. Having said that, almost universally, everyone I spoke to enjoys the anatomy and excite associated with most surgery.
Later

Why not change the system? Are there not resident education committees and resident representives to the American College of Surgeons, the ACGME, and other standard setting organizations? Again, I think its simply about providing the right kind of incentives for change...

 

[Skylizard]

Originally posted by drusso
Why not just implement a zero tolerance policy .... student abuse?

I think most (residency) programs are markedly restricting the amount of abuse they will tolerate in their programs. I suspect the work hours thing is also part of the over all effort to make residency more of a learning/training experience and less of a hazing experience.

Originally posted by drusso
...The Canadian resident education system is far more generous with maternity/paternity leave and child care issues. Why not simply offer high quality child care options for female (and male) residents with young children?

That would be lovely. However, hospitals at this point have difficulty hiring the basic staff to ensure work hour restrictions. Hospitals have difficulty hiring enough nursing staff. Canada has a very socialized society and healthcare which enables them to do some of these things while sacrificing other things. Please note, I am not trying to open a debate on socialized medicine or government. I am simply stating that Canada has quite a different system and the USA would not be able to simply do the things done in Canada without a broad systemic change. Remember, we already have problems with hospital funding and how much reimbursement the federal government is willing to provide.

Further, I believe individuals are able to apply for some Canadian residencies if they desire. As an individual looking at the Canadian system, I would not like to train or work in Canada. That is not to say it is bad simply that it would not be the right environment for ME.

Originally posted by drusso
I think its simply about providing the right kind of incentives for change...

It is not simply incentives, there are financial issues to contend with as well.

 

[droliver]

I think the "abuse" of students is really not much of an issue. I'm not sure what that means, drrusso do you have something specific you're thinking of?......What I have noticed is that frequently older students & residents tend to resent the hierarchal nature of med school and post-graduate training. One of my fellow interns in 1998 who was in Neurosurgery, was a former Marine intelligence office & he had all kinds of trouble that year with authority from his chief residents who were 10 years younger then him. Every resident I've ever seen (surgery or otherwise) who had a management career prior to med school or is going back & retraining in another medical specialty has had these same kind of issues.

 

[handygirl]

Please don't match in my program . . .

 

[zpdoc]

rock on pba.

Call me masochistic, but now that resident work hour limiits have been imposed, I'm a little disappointed. I still think I will be able to be trained to be a competent surgeon, but I know the residency that I match into will be somewhat watered down. Part of this whole experience for me is challenging myself to the utmost limit of what I am capable of, and coming out of the fire knowing that I have gone through what only a select few people could handle to be a supremely competent professional.

Oh well, guess I'll be doing a lot of sitting around and crying with all my extra time off.

 

[handygirl]

Believe me, I think most surgical residencies have been watered down for quite some time. While you may have spent 100+ hours in the hospital, believe me, only a small portion of it was "er-like" drama or even remotely related to medical education. 80 hours per week is more than enough time to learn to become an excellent surgeon. Hospitals just haven't been willing to release the resources needed to shave off the 40 hours of "fluff" per week that residents were doing.

 

[jth9]

I was hoping to discuss this topic in my thread titled "Generation X" but I'll summarize here. On the interviews I've gone on so far, I got the impression that the program directors of surgery have sat down and come to the conclusion that we're of "Generation X," meaning we care more about family and personal time than previous applicants. Obviously, this point was brought up with less than favorable connotations. From the start of the interview, I felt pressured to defend myself from being labeled as "lazy"

I agree with pba. people should/do know what they're getting into by applying for general surgery. Those who feel otherwise go into surgical subspecialties.

 

[Skylizard]

Originally posted by pba
...this is not to say those above us should be purposefully cruel...-pba

pba, are you in surgery or trying to get into surgery? I can tell you from first hand experience that a great deal of the 110-120 hours per week are not true learning experiences. Everyone defines "malignancy" differently. I define it as wasting my time simply because I am a resident. On those long 115 hour weeks, I found myself missing ALL the basic science lectures, all the M&M conferences, and all the lectures in general. Was it because I was in the OR? Hell no, it was because I was a resident doing the tasks left behind due to insufficient nursing staff or some other menial task. This is of course the kind of thing that got Yale in trouble. Residents doing non-academic menial tasks so the funding for ancillary care can be placed elsewhere.

Am I saying I should be in the OR 24/7? No. What I am saying is that a residency is supposed to be educational. Currently, I have seen residencies in which the only education a resident gets is what they can squeak some spare time out inorder to give themself. It makes no sense to have educational conference time that is unprotected so almost ALL interns are paged out of the only real learning there is to obtain on a given day. It makes no sense to beat people down with heavy work hours so the only thing you can do when you get home is try to get 4 hours of sleep before the next AM rounds. Surgeons are supposed to be the smartest and quickest thinking individuals with the greatest "fund of knowledge". Yet, it is undisputed and well documented that higher end learning and critical thought are absolutely inhibited by sleep deprivation. I sure as hell would not want my potassium replacement handled by interns who are undergoing the abuse, the hazing, and rite of passage I went through as an intern.

Anyone can spout macho statements about how they want to experience Q2 call for five years. However, someone that wants to be an excellent surgeon will be seeking the best learning environment and 5 years of Q2 is not in anyway the best environment to learn the multitude of information you should be learning in the field of surgery. Being a good surgeon comes from a place higher on the body then your hands.

Is there a great deal of whining? Yes. Is there a great deal of truth behind the whining? Yes. If for nobody else, you should be trying to ensure you are in the best learning environment for your future patients. Because, when all is said and done, the oral boards are oral and not an evaluation of how good you suture or how well you can stay awake for 48 hours. The surgeon in front of you will be asking you to calculate ICU nutrition, electrolytes, fluid replacement, etc.... It is kind of a shame that so many surgical residency graduates are unable to pass the written and oral boards. It is sad that so many residency graduates have to take a board review coarse of classroom lectures to learn the science they should have learned in residency. I can tell you these are not stupid people. I have seen vascular surgery attendings at university medical centers that have failed the boards THREE times. I can point to CT surgical fellows that have failed the general surgery boards during their first year of fellowship at places like the University of Michigan.

If you want to just grunt and grone, go to a Q2 program. If you want to be able to learn the science of surgery, you'd better be sure you are in a program that values the educational aspect of residency as much as they value the cheap man power of residents.

 

[Skylizard]

Originally posted by pba
"i am not responsible. others should do things for ME because I am ENTITLED to x" which is ridiculous...everyone wants to have their cake and eat it too...this 80-hr work week is such a sham...I am sick of resident rights and what not. it's all i ever hear about from everyone. the concept of "dedication" no longer seems relevant to medicine...I am not entitled to jack-pba

The one thing a surgery resident is "entitled to" regardless if you think you are or not is quality education and the ability to be fully boarded. Every surgery resident that puts in the time and is graduated should be able to pass the boards. They are entitled to that expectation!!!

 

[Skylizard]

Originally posted by pba
...i dont think that ALL surgery residents fail their boards...

I am definately NOT saying "ALL" surgery residents fail their boards. I am saying that no residency grad should be failing. Further, nobody who gets great reviews from a top university program sufficient to land a spectacular fellowship should fail the boards. While I know Frieda is known for lacking accuracy, it is shocking to see the board first time pass rates. It is also telling to see the pass rates in "low malignancy" programs in comparison. The one caveat being those with dyslexia or some other limiting factor.

Originally posted by pba
...i have no experience as a resident. i do know what it's like to be q3, studying for step2, and taking the exam post call. it was hard...this is not the same as surgery q3 for 5 years and then taking boards but the point is dont complain...-pba

Your right, you haven't been there. Having said that, your overall medical school teaching should be preparing you for the boards (step I & II)and the studying you did during surgery is "review". Having said that, your experience just emphasizes that certain situations are NOT conducive to high end learning even if you may have pulled it out in the end.

Originally posted by pba
...insult me by calling it "machismo b.s." but it's not for show.-pba

It was not a statement intended as a directed insult. I should have quoted the word used by another in this discussion..."masochistic".

However, in closing, I still stand by my positions and statements. Residency should be focused on learning first and foremost.

 

[UI2003]

GS is popular again! How many people in your class have jumped on the GS bandwagon? Coming up through medical school there were only about 4-5 of us and then just this fall I got word that the number has jumped to 10 or more! What the hell?!

 

[Jay Shoaps]

It's wierd that you mentioned this. Today a classmate of mine mentioned that they knew of ~10 people from my school applying, while I had thought there were more like a 3-4. Could be its on the rebound.

 

[Skylizard]

Originally posted by Jay Shoaps
Could be its on the rebound.

I am not so sure it really is on the rebound. I suspect there are two things going on with these numbers.

1. I think individuals who thought they would not be competitive in surgery due to any number of reasons (usmle, grades, or lack of research experience) are now hoping surgery programs are hard up and will now take a second look at them. Thus, the "B-team" of applicants is now growing. Some individuals that did not think they had a chance in hell have seen the "big university" names that did not match over the past several years. This has probably given a false sense of hope to some.

2. I think individuals who were unwilling to work 110-120 hours per week are putting a lot of faith in the RRC 80 hour work week rule.

In short, I think the increase in numbers is more likely do to an expansion in these groups of applicants. I am not so sure surgery in general has truely increased in popularity.

 

[UI2003]

Thanks guys -

Those might be some good reasons - however, I think the thing that scares (annoys) me the most about the sudden jump in numbers is the prospect that several of these folks are only applying because of the 80 hr thing (ps - most if not all the programs I've interviewed at are applying for the 10% increase so our hours will be closer to 88-90/wk). On the bright side, at least I can be sure the program I match with won't have trouble filling spots...

 

[outforblood]

Hey pba. the 80hr/wk rule only refers to how many hours the
residency programs MAKE you work, if you really believe in your statments, no one is stopping you from working all 168hrs of th week, but good luck with all that.

 

[droliver]

No, actually there will be enforcement of these rules pretty strictly whether you (the surgery resident) like it or not. There's a real prospect of random, unannouced "body counts" to make sure that post-call residents aren't in the hospital (this has been done @ some places already). I would imagine that you will eventually have some kind of time clock you punch in/out on to document your hours rather then rely on an honor system as there is going to be now. What's going to drive this is the huge medical-legal liability that been established by (arbitrarily) putting an 80 hr week +/- 10% into black-letter law so to speak. Any complication, death, etc... that occurs when someone who happened to be post-call or greater than their 80 hrs is involved will be blood in the water for malpractice lawyers. The terrifying liability for the institutions & training programs who are the deep-pockets here will quickly make non-compliance a non-issue. It also raises a very real prospect that smaller programs at many community-based type systems will close their program rather than try to come into compliance

 

[UI2003]

I don't know about most community programs but if they are private, running at a profit and non-resident dependent, the new work rules do not make a difference to them.

 

[UI2003]

Actually the 80-hr mandates have been coming down the pike for about 15 years - so it has nothing to do with the "Gen-X" mentality. Several program directors I've spoken to knew it was coming and have slowly been making changes in their call schedule for years. But this is neither here nor there (nor is it the point of this thread) - let's get back to the # of applicants debate!

 

[outforblood]

I don't think you can seperate the two topics.
Less hours means more applicants, you can't have a clearer correlation.

But for as far as pba's complaints, you have to think about the patients. Although you may get off on 170 hours of work per day, it's simply not a safe environment for your patients.
Don't get me wrong, i applaud you for your desire, and even share many of your opinions, but you can't forget that the reason we're all here is for the patients, and an overworked resident is a dangerous resident.

 

[Skylizard]

Originally posted by pba
all i really want are all these regulations to leave me alone and let me do what i want.

I find this statement to be the most telling. Especially as it comes from the individual chanting about generation complainers and entitlements. The bottom line is residency has never and will never be about being left alone to do what you want! From my experience as a surgery intern I can tell you the hours after 88 were not learning or operating. So, if you really want those long hours, do your 88 hour week and go home and stay awake. It would be just as educational.

Originally posted by UI2003
Actually the 80-hr mandates have been coming down the pike for about 15 years -

That is correct. Everyone talks about the "new" rules. This has been coming for a long, long, long time. This idea that some how our new general surgeons will be poorly/less trained due to the 80 hour week is silly. Everyone wants to believe the abuse they suffered was some how necessary in order to be the competent surgeon they are now. Get over it, most of the surgeons I know are high caliber despite their program and not because of their program. If you press a surgeon as to how they learned so much and became who they are, he/she will likely say it is due to THEIR discipline and ability to read instead of fall asleep when they got home. Not one of the surgeons I have spoken to can specifically claim the sleep deprivation or 20-30 hours of scut work per week made them good.

Originally posted by outforblood
...an overworked resident is a dangerous resident...

I think this speaks for itself and is backed by a multitude of research, avoidable M&M cases and quite a few malpractice suits. I think those who are not even in surgery residency yet and are crying about how they were so looking forward to the long 120 hour work weeks are just:

a. trying to sound cool or
b. showing their lack of wisdom, knowledge, and experience.

People with greater knowledge, greater experience, and far more training have looked at this matter. It is clear that 120 hour work weeks HURT higher critical learning and patient care. Sleep deprivation does NOT enhance learning.

I am certain almost anybody can overcome 110-120 hour work weeks....it's been done for a long time. There is nothing more to prove on that front. The question is can you become a skilled and knowledgeable surgeon up to date on the latest voluminous research? The challenge is learning not proving you can survive sleep deprivation. Keep your eye on the correct prize.

 

[droliver]

Originally posted by Skylizard
Remember, around 20 or so years ago general surgery residency was a 3 year program.

This idea that some how our new general surgeons will be poorly/less trained due to the 80 hour week is silly. Everyone wants to believe the abuse they suffered was some how necessary in order to be the competent surgeon they are now. Get over it, most of the surgeons I know are high caliber despite their program and not because of their program.

I think this speaks for itself and is backed by a multitude of research, avoidable M&M cases and quite a few malpractice suits. I think those who are not even in surgery residency yet and are crying about how they were so looking forward to the long 120 hour work weeks are just:

a. trying to sound cool or
b. showing their lack of wisdom, knowledge, and experience.


I

1) surgery residencies have never widely been 3 years (after internship I assume) since the Halstead model was adopted early last century. There was a brief experiment in the early 70's with 4 year programs @ a FEW programs that was aborted after the failure rate on their board exams was dramatically higher. For the better part of the twentieth century, training at many university programs was a good deal longer then 5 years (you were done when the chairman said you were)

2) I've yet to meet any surgeon who does not feel that mandated 80 hr workweeks (and the associated gymnastics with schedules that will be required to meet that) will not negatively impact the training of surgical residents. Depending upon what days of the week you call falls upon, up to 40% of your operative days can be lost in Q3 or Q4 schedules (the most common scenarios)

3) the work hour limits have little if any evidence to show that there will be improvements in measurable outcomes. The logic for it is empiric for the most part & the statutes ignore some of the data,regulations, and other measures adopted by the FAA, maritime workers, and other fields with fatigue-related performance issues have. I'm not going to argue that fatigue doesn't lead to some errors, but rather the solution for it proposed by the ACGME is a rather blunt tool that could be looked at better. Having done ~15 months of Q2 call and worked a lot of 120 hr weeks, I will agree with you that these extremes make for chronically fatigued physicians (though I had a blast those years) and should be relics of a different time. It is however hard to get enough exposure with the proposed rules, especially as a junior resident where your in house call tends to be concentrated. Those hours in house add up real quick. I think 100 hrs would be a more reasonable goal, and realize that there are many rotations that are less rigorous then that and a few more.

 

[Skylizard]

Originally posted by droliver
1) surgery residencies have never widely been 3 years (after internship I assume) since the Halstead model was adopted early last century. There was a brief experiment in the early 70's with 4 year programs @ a FEW programs that was aborted after the failure rate on their board exams was dramatically higher.

I have no doubt your dates are probably accurate. I am likely mistaken.

Originally posted by droliver
I've yet to meet any surgeon who does not feel that mandated 80 hr workweeks (and the associated gymnastics with schedules that will be required to meet that) will not negatively impact the training of surgical residents.

It depends on how the surgical attendings choose to utilize the residents. Frankly, I do not think the majority of cases a junior resident is exposed to should come from late night emergencies. I have been on surgical rotations with call as few as q5 and spent more time in the OR then when I was q2. I also learned a great deal more. What you need to ask is are these gymnastics for the purpose of education or to protect resident coverage so attendings do not have to cover? I do not know the answer but I have seen numerous circumstances were the issue was more for attending convenience and less for resident education. I think this point is emphasized when residents do not even have protected lecture time in numerous institutions.

Originally posted by droliver
the work hour limits have little if any evidence to show that there will be improvements in measurable outcomes.

What I refer to is the research that shows fatigue hurts higher thought processes and decision making. I do not believe you will ever get good "outcomes" data. M&M is protected education discussion and confidential. I have seen too many M&M cases that should never have occurred. I have also heard it repeatedly stated "I was tired and in a rush". I have seen one senior resident repeat the exact mistake of another senior resident within a two week period. Surprisingly, both cases presented at M&M. The repeat offender was unaware this error was presented the preceding week...he was asleep during M&M!!! I have seen chief residents cut the common bile duct in a "routine" lap chole, order 2 grams of potassium and 20 mEq of magnesium all at the tail end of a 110+ hour week. Overworking your house staff can have dangerous consequences for the patients. I can also tell you that I do not remember 25-30% of my intern year so I doubt I can say it was an educational experience. Having said that I would do it again but without any illussions that it some how made me a better physician.

Originally posted by droliver
The logic for it is empiric for the most part & the statutes ignore some of the data,regulations, and other measures adopted by the FAA, maritime workers, and other fields with fatigue-related performance issues have. I'm not going to argue that fatigue doesn't lead to some errors, but rather the solution for it proposed by the ACGME is a rather blunt tool that could be looked at better.

I completely agree that the rules are blunt. I do NOT necessarily think they are the best answer. Unfortunately, too many attendings are unwilling to come up with an alternative that will limit the mundane and enhance the learning. This has been going on for a long time. The rules are being enforced by outside because those inside are unwilling to change. I believe alot of this is an attempt to ensure a medical body legislates before the Federal congress does.

Originally posted by droliver
Having done ~15 months of Q2 call and worked a lot of 120 hr weeks, I will agree with you that these extremes make for chronically fatigued physicians (though I had a blast those years) and should be relics of a different time.

I agree with you. However, it would not likely become a "relic of the past" without some "blunt" approach outside the surgery community. Surgery programs have had a long time to approach this. It is amazing to look at big university programs that once threatened with their accreditation suddenly hire the ancillary care that was lacking. Programs suddenly are coming in line with guidelines in 7-8 months when they could have done it over years. Unfortunately most of the leadership has proven itself time and time again to be reactionary and not visionary. Tell me how Yale with all its resources could have gotten into its difficulty?

Originally posted by droliver
It is however hard to get enough exposure with the proposed rules, especially as a junior resident where your in house call tends to be concentrated. Those hours in house add up real quick. I think 100 hrs would be a more reasonable goal, and realize that there are many rotations that are less rigorous then that and a few more.

The concentration will have to be decreased and the call will have to be spread up the line. One of the bad things I see/hear in surgery residency is the statement, "that's intern work". There really needs to be more team work and less subordination.

In closing, I appreciate your response. I by no means want to suggest I know the right answer. I do NOT. However, surgery will change and it will require surgical leadership to ensure the change is for the betterment of training as opposed to the betterment of lifestyle at the expense of training. The surgical community needs to lead and be creative instead of being dragged kicking their heels.

 

[Skylizard]

Originally posted by pba
1)Learning isnt only OR. Managing floor patients is important for surg too. More time = more experience. The claims about q2 vs q5 may be true at times. it may not be true at others. -pba

Originally posted by pba
...i am sick of resident rights and what not. it's all i ever hear about from everyone. the concept of "dedication" no longer seems relevant to medicine....when i can operate like a champ, then they can leave me alone.
-pba

I believe in one of my other replies I stated something similar to your comments (i.e. learning outside of the OR).

Originally posted by SomeOne
This is of course the kind of thing that got Yale in trouble. Residents doing non-academic menial tasks...Am I saying I should be in the OR 24/7? No. What I am saying is that a residency is supposed to be educational...Being a good surgeon comes from a place higher on the body then your hands...when all is said and done, the oral boards are oral and not an evaluation of how good you suture or how well you can stay awake for 48 hours. The surgeon in front of you will be asking you to calculate ICU nutrition, electrolytes, fluid replacement, cardiac output, drips, etc....

Originally posted by pba
2)as for the attending coverage issue.... medicine is a demanding field. i would rather work hard for 5 years and help attendings out now than have to be on every 4th night as a 60 yr old. work hard now, get paid later works with me.-pba

I guess you must be planning on working in an academic/teaching hospital. Realize that numerous surgeons are working private practice without residents and doing just fine into age 60.

Originally posted by pba
3) "that's interns work." i guess it is. i dont buy equality. i am not an attending. i am not a chief resident. somebodies gotta do it. just like the medstudent's job is to put in a foley, do a rectal, put the h&p up on the OR board. the chain of command is pretty good. you have very focused responsibilities and you get good at them. you dont have to worry about anything else. it's all clear. -pba

I agree somebody has to do it. However, it is PHYSICIAN work. In private practice the surgeon or their PA will be doing these tasks. These task should not be viewed as being beneath any member of the team. As a military person, I strongly believe in a chain of command. However, I have seen too many times when certain residents get big headed and so tasks don't get done because it was beneath them and the intern was off on their long weekend. I have also seen interns pulled out of intern cases to go do a quick H&P because it was beneath the third year....who was having lunch.

Originally posted by pba
4) i want acreditation boards to leave me alone. if a chief tells me to do something, i'll do it. it's that simple. the chain of command is probably one of the things that draws some of us into surg. teamwork means all the interns helping each other out as much as possible with whatever work they are told to do. -pba

Welcome to medicine. There is managed care and accreditation boards that must be answered too especially if someone else is paying for a chunk of your training. These accreditation boards are in effect part of the larger chain of command. They are a governing component and you will need to work within their guidelines and how they say to or find someone else to subsidize your training or pay your surgical fees.

Team work means the whole team working together. When I was an intern my team was not simply limited to the interns it was the entire team right up to the chiefs.

Originally posted by pba
during my AI it was good to have nurses call ME. I had to think. I had to decide what to do for stuff. granted it was at a 4th yr level, but I still liked it and learned from it. call is good. staying the day after call keeps your OR experience there.-pba

I don't know what a nurse is calling the med-student for during the night. If they were doing you a favor and letting you know what the resident was doing that is one thing. However, MD=makes decisions. If you were making independent decisions on patient care in the middle of the night you were practicing medicine without a license. You should not have had to decide anything. If you did, it's interesting. I know as a patient I would not want my nurse calling a med-student to make any decisions...even if the med-student was learning something.

Originally posted by pba
internship is a scut yr. i expect it to be. but chief yr should be operating. it's hard for many people to understand a work-oriented personality that really respects the chain of command, i guess. -pba

You know, in one form or another, you have repeatedly stated something to the effect about you being difficult to understand. I think most people who go through med-school are work oriented. I think most if not all in surgery are work oriented. I think every residency has a chain of command. I know when I went through med-school, GS internship, military training, etc... I was pretty damn work oriented and respected the chain of command. I do not think many people are confused about your personality. I do not think many people have any difficulty with individuals respecting the chain of command. However, based on your comments, I get the sense your idea of chain of command ends within the hospital. The reality is that those financing your training will be part of your chain of command. Those paying surgical fees will also be part of your chain of command. Those that accredit you, your hospital, your clinic, and/or training will be part of your chain of command. If you are someone that prides themself on "really respects the chain of command", you had better come to terms with these other entities. If there are issues, those higher in your chain of command will address them. Your job will be to do what your told...I think you said that. It looks like you might be told to go home post call. Respect the chain of command and go home without whining.

 

[Celiac Plexus]

MY reasons for bein' an 80 hour hatah:

1. Ya gotta manage your patients not just operate on them. EVERY surgeon that I have met on rotations knows ALL of the management options and makes the "medical" decisions as well as the surgical decisions. I want to be on the floors at 3AM when the fit hits the shan so I can learn how to behave and make crucial decisions. I do not believe that one can learn that from a book.

2. Stamina is key. How can a marathon runner build up stamina without running marathons occasionally? How can you expect to be comfortable operating/making decisions under duress and fatigued without having experience doing it?

3. Surgery is not a shift-work job. It's a job AND a lifestyle. I am going in to surgery with the expectation that I will make it my life's work and passion. I am an all-or-nothing, gung-ho type. If I wanted to punch a fargin' time card, I would go in to emergency med.

4. I am a control freak and I hate the idea of not being around for every little thing that happens to my patients. I need to know everything, and see everything, and understand everything. I can't do that if I have to go home at 10AM.

5. I like working in a regimented, chain-of-command environment. I like the surgical culture. I respect and want to be like the surgeons that I know. Therefore I want to go through everything that they went through.

6. Call me an idealist, an idiot, or a fool.... But I believe that to be a doctor is a great privilege and honor. To be a surgeon is the an amazing privilege and I would do ANYTHING to become one, and serve the public in such a capacity.

7. The surgeon on ER is my favorite character, and I KNOW he would HATE the 80 hour work week... just like I will.

Peace, and good luck!

 

[womansurg]

Originally posted by Skylizard
The reality is that those financing your training will be part of your chain of command. Those paying surgical fees will also be part of your chain of command. Those that accredit you, your hospital, your clinic, and/or training will be part of your chain of command. If you are someone that prides themself on "really respects the chain of command", you had better come to terms with these other entities. If there are issues, those higher in your chain of command will address them. Your job will be to do what your told...I think you said that. It looks like you might be told to go home post call. Respect the chain of command and go home without whining.

Nicely put, Skylizard.

We've talked about this on other threads. The constructs and limitations as proposed by ACGME are pretty incongruent with surgery training - clearly they were designed by medicine doctors. It's obvious in the language and in the formatting.

Do we need limitations on surgery resident work hours? Yes, the data are incontrovertable. Frank medical error is the end of the line of mismanagement that occurs when people are suffering sleep deprivation. Long before the dumb mistakes occur, workers become emotionally unavailable to their patients, rude to ancillary staff, and compromising in times and energies spent in evaluation and treatment - none of which are compatable with the delivery of competent medical care.

Surgery training programs have done a terrible disservice to patients and to trainees for a long time. It's time for some accountability. Eighty hour work weeks and 24 hour limits probably are not the answer for surgeons in training - these are not consistent with the nature of surgical practice. But relief from 40 hour shifts without a break, every other night call, 120+ hour work weeks, months without a day off...these are reasonable goals.

 

[Skylizard]

Originally posted by SomeOne
It depends on how the surgical attendings choose to utilize the residents...What you need to ask is are these gymnastics for the purpose of education or to protect resident coverage so attendings do not have to cover?...Overworking your house staff can have dangerous consequences for the patients...I completely agree that the rules are blunt. I DO NOT necessarily think they are the best answer. Unfortunately, too many attendings are unwilling to come up with an alternative that will limit the mundane and enhance the learning...I believe alot of this is an attempt to ensure a medical body legislates before the Federal congress does...it would not likely become a "relic of the past" without some "blunt" approach outside the surgery community. Surgery programs have had a long time to approach this...Unfortunately most of the leadership has proven itself time and time again to be reactionary and not visionary...surgery will change and it will require surgical leadership to ensure the change is for the betterment of training as opposed to the betterment of lifestyle at the expense of training. The surgical community needs to lead and be creative instead of being dragged kicking their heels.

I hate to say it but those bitching and moaning about glory years past and lost are out of touch and ....frankly, part of the problem. Complaining about generation-x is futile and hollow. Get over it and get creative. Surgery will change. We need to ask ourselves, will surgeons chart the course of surgical education or will they abdicate their responsibility and be dragged kicking and screaming by psychiatrists and internists? Who will catalyze that change and determine the shape of future surgical training?

While I do not claim to know the answer to these questions, I am pretty sure that those trying to hold onto the old q2/120 hour work week and wrapping themselves in the "chain of command" are not likely to be the future shapers of surgical education.

Good luck at the windmill

 

[Skylizard]

I appreciate the excellent conversation of this thread. Many thought provoking comments.

 

[Skylizard]

Originally posted by pba
...i have NO experience as a housestaff officer, so obviously my input is more based on attitude and expectations than experience.

Not to fret, you will likely get the experience.

Originally posted by pba
...you spend all day operating. saturday morning you round and cant find a graft pulse even with a doppler. your 80 hrs are "up"...i really reallly really dont want to go home. and i think everyone who is serious about doing surgery understands that. that is part of the draw of surg...i think everyone can agree on the negative effects of the 80 hr workweek on this scenario...
-pba

Originally posted by SomeOne
? the rules are blunt. I do NOT necessarily think they are the best answer. Unfortunately, too many attendings are unwilling to come up with an alternative that will limit the mundane and enhance the learning. This has been going on for a long time. The rules are being enforced by outside because those inside are unwilling to change. I believe alot of this is an attempt to ensure a medical body legislates before the Federal congress does?Unfortunately most of the leadership has proven itself time and time again to be reactionary and not visionary?I appreciate your response. I by no means want to suggest I know the right answer. I do NOT. However, surgery will change and it will require surgical leadership to ensure the change is for the betterment of training as opposed to the betterment of lifestyle at the expense of training. The surgical community needs to lead and be creative instead of being dragged kicking their heels.

As per punching a time clock:

Originally posted by SomeOne
These accreditation boards are in effect part of the larger chain of command. They are a governing component and you will need to work within their guidelines?The reality is that those financing your training will be part of your chain of command. Those paying surgical fees will also be part of your chain of command. Those that accredit you, your hospital, your clinic, and/or training will be part of your chain of command. If you are someone that prides them self on "really respects the chain of command", you had better come to terms with these other entities?

I think everyone is frustrated. However, frustration is not leadership. When the surgical community assumes leadership of this issue and stops crying fowl, we may have a better solution. But, if the surgical community continues in its unwillingness to address the issues of scutwork, overwork, and hazards of resident fatigue, internists and psychiatrists will set rules that enhance resident lifestyle at the expense of training.

 

[pickaname]

You know, after all this stimulating conversation, I still don't see where the numbers in the original post came from.

Please give us the source!

 

[enceph]

Originally posted by Skylizard
Surgeons are supposed to be the smartest and quickest thinking individuals with the greatest "fund of knowledge".

 

[njbmd]

Hi Folks,
My program is going to a night float kind of a system in order to stick within the 80hr work guidelines. The problems is that even though we will be working 80 hours per week, we have do the same amount of work with less actual downtime. I might be doing 80 hours but it's going to be 80 hours at breakneck pace. Most services are going to a one-intern system where you will enter the hospital at about 0600h and leave about 1800h. You have to get all of your floor work and dictations done within that time frame. The night float will be covering multiple services and doing the night admissions. They will not be discharging or helping you with your chores. Your OR time will go into the toilet because you will have to spend your time getting the service work done.

While I just came off of a service where I routinely put in 140-hour weeks at the hospital, I had loads of opportunity to study, practice and operate. Guess what? My attending physician (and residency director) was putting in the same hours as I was because I was operating with him almost all of the time. It was the best learning experience of my intern year so far. My cases tripled on that service along with the increased hours. Next month, we start our night float system. For me that means that my SICU rotation has been swatted in order for me to join the float pool. This was a rotation that I was actually looking forward to.

For all of those folks who are thinking that the 80-hour work week is going to mean that your surgery residency is a "cake-walk", you are in for a sad awakening. I am in one of the least-scut programs in the country but we are busy. There is a set amount of work to be done and you are going to have to get it done in less time. Translation: you are going to be constantly and drastically busy for those 80 hours. Get out your running shoes now.

njbmd