quitters

[smq123]

Anyone ever take Provigil to stay awake? It's approved for narcolepsy and shift work sleep disorder (or whatever it's called when you work the night shift)? I hear it works amazingly well to keep you awake and alert. Just curious.

No. But I'd be interested to hear from people who use it long term. I had a patient whose doctor had given her Adipex for "fatigue." She was on it for 3 years, and trying to figure out how to get her off of it was...interesting.

It sucks. People now are just doing it "for the love of the game," etc.....if they were into hard core drugs, I guarantee the Jonas Brothers would be much better....

I don't know....I'm not that optimistic. I have the sneaking suspicion that they could take all the heroin in the world, and their music would still be awful.

I should probably add a disclaimer, though, that I haven't really listened to any Jonas Brothers "songs" and that my main exposure to them was in the South Park episode with the purity rings.

---

Members don't see this ad.

 

[JackADeli]

"Not uncommon?" To be putting in CONSISTENTLY 20 hour days? Come on. ...I find it basically impossible to believe that anyone, at any time, was consistently working 20 hour days, at any point in the history of surgical training. Its barely conducive to life, much less education...

...But imagine this being the norm for a 5 year training program, month in and month out. Its preposterous. Human beings werent made out of tougher stuff 40 years ago...

...You claim that human beings are capable of this. I dont agree. Not for extended periods of time...

It is not really in the realm of possibility that it was "not that uncommon" for residents to consistently work 120-130 hours/week, on a regular basis...

Going to throw some wood in the fire here...

...You might be correct. Maybe it really was "not uncommon" for residents to be consistently working 120-130 hours/week. Its impossible for me to know, since I dont have a time machine...

This is probably the most acceptable statement you made to this point. It was in fact the frequency of occurence of 120-130 hours/week that ultimately resulted in ACGME rules/mandates on work hour limits. There is a multitude of historic information on this point. The term "resident" comes from the fact that trainees resided... i.e. pretty much lived at the hospitals in which they trained. For you to argue, that this was a rare occurence, or near impossibility, you clearly have not looked at historical norms.

As for WS expressing her experience, I can vouch for at least one of those years. It was not simply a couple rotations or a couple weeks of endurance. My spouse reminds me (as I recall little of the year) of my 120-130hr/wks over the year. I do remember feeling privileged to get home post-call by 7pm to enjoy planting my face in the meal my spouse prepared (again don't remember the menus).

...But can you at least agree with me that, given the following:

1) I am a human being.

I'll give you that one. I don't believe sci-fi and reality as far as on-line "AIs" has reached the level to facilitate your being artificial and carrying on this debate.... though the flawed argument could be representative of AI programming flaw/infancy.

...But can you at least agree with me that, given the following:
2) I have worked 100 hours/week for several weeks in a row, and know what it feels like

Nope, we can't agree or speak to your particular experiences... we will just have to take your word for it.

...But can you at least agree with me that, given the following:
3) I have a modest understanding of typical human biases

No agreement. We don't know you... and your arguments do suggest a lack of experience and/or understanding..

...that it would be absolutely insane for me to accept ANY amount of anecdotal, self-reported recollections, that concluded that it was "not uncommon" for residents to regularly work 120-130 hours? Again, I'm not saying it didnt happen. Maybe it did...

So, check with the ACGME/RRC and historical information. Much of medicine is based on anecdotal data. Numerous patients have been saved over the years by such data. That is not to say it is the best or that it is unflawed. But, for you to outright dismiss or make arguments on topics you clearly have no first hand data, that is where the insanity lays. Many things have occurred in history... with little more then oral tradition as the basis of reports. Dig a little deeper before you make claims as if some sort of expert. The fact that you are a "human being" and feel you can not survive what others have endured... do not impose your perception and/or belief in your limitations on others. Numerous folks/humans could not achieve these hours, thus pyramidal systems and huge attrition. I enjoyed walking down to the archives and reviewing the "yearbooks" that showed such large PGY1-3 classes that ended in a chief year of only 4 graduates. Yes, the long hours were quite common/routine. Yes, the human endurance to tolerate it for the entire five years was not as a common. yes, those that ultimately made it to be one of those four chief resident grads were often not so nice human beings.

Final point, plenty of surgeons in active practice regularly work over 100hrs/wk. Plenty of folks/CEOs regularly work in excess of 100hrs/wk. After full implementation of the ACGME/RRC hrs and on-call rules, my residency found numerous attendings working more hours per wk then residents. As for bias and recall.... I recall little of my long hour wks to recall exact numbers... that is why all I need do is look at the computerized/punch clock data that was collected. The numbers are always shocking. I know they shocked the RRC/ACGME.

There are plenty of reports, of highly successful folks, in numerous fields, that regularly work such hours.... You can go from the likes of Donald Trump, to active duty soldiers at war, to Navy SEALS, to Indian Rickshaw "drivers" (though Rickshaw runners may not report 120hrs/wk, [I think ~15hrs/day]their reported levels of labor would probably defy your belief in human capacity).

Instead of making declaration and denying the "achievements"/"challenges" of those before you.... can't you simply be grateful that you will very likely not be asked to do the same? And, if beyond you capacity to thank God/Yahweh/the stars that you will not be asked to do the same, can you not insult those of us that did? Because, through your "interesting argument", you are declaring us liers.

 

[Winged Scapula]

Anyone ever take Provigil to stay awake? It's approved for narcolepsy and shift work sleep disorder (or whatever it's called when you work the night shift)? I hear it works amazingly well to keep you awake and alert. Just curious.

I took a single tab on one occasion and I was up cleaning at 0300 and chattering away according to my ex. Most energy I'd had in years but was too scared to take more than the one.

 

[Buzz Me]

I took a single tab on one occasion and I was up cleaning at 0300 and chattering away according to my ex. Most energy I'd had in years but was too scared to take more than the one.

Ha ha, would have LOVED to have seen that! A hypomanic WS.

 

[Winged Scapula]

Ha ha, would have LOVED to have seen that! A hypomanic WS.

Yeah he loved it too, although was a bit dismayed that I took 1/3 of the dose he took and he felt no effect.

It really was sort of scary in retrospect because I felt *so* good - alive, energetic, sexy - a superhero with none of the side effects of No-Doz: no shakes, no being awake but still feeling tired. It was like I imagine meth would be like.

 

[Shoushu]

Anyone ever take Provigil to stay awake? It's approved for narcolepsy and shift work sleep disorder (or whatever it's called when you work the night shift)? I hear it works amazingly well to keep you awake and alert. Just curious.

My psych professor told us about it. Provigil is expensive. WS et. al, How did you get it? $7 to $10 per 200mg pill. Each 200mg can keep one awake 36 hours easily, as its half-life is 18 hours. I suppose you can ask other doctors to write you a prescription, or are docs allowed to diagnose themselves with Excessive Sleep Disorder?

Residents get health insurance, vision/dental, disability, MedMal insurance, etc, right? Wonder if residents get the drug covered by insurance, and only pay a tiny co-pay. Afterall, the insane hours worked merit SWSD or Excessive Sleepiness.

The same psych prof told us true stories about residents being so tired as to be hallucinating while doing surgery. After surgery, "Like Highway Hypnosis, I was on autopilot while cutting the patient, seeing shadows that arent there. Not sure how I .. uh.. . got home." Another sleepy doc was to list 9 things for a nurse (maybe PA?) to do, and wrote: "1. Give patient whatever durg and 2. .. 4. 9. 10.", not realizing she skipped 3, 5, 6, 7, 8. My professor showed a scanned sheet of her handwritten "orders" , so it's true！！

 

[PostCall]

dude 120-130 hrs/wk were totally legit. the old school attendings still talk about it with pride, as they should. one trained back in the day (like the 70s) and was saying how once during his residency he didn't leave the hospital for an entire month...as in the only time he left the hospital was to walk around the block to get some fresh air/unwind and then come right back. this was back in the pyramidal system when everybody started as a prelim and only a few ever made it to chief resident. haven't you noticed how bad azz your old school attendings are...its cuz only the best of the best made it.

 

[Shoushu]

dude 120-130 hrs/wk were totally legit. the old school attendings still talk about it with pride, as they should. one trained back in the day (like the 70s) and was saying how once during his residency he didn't leave the hospital for an entire month...as in the only time he left the hospital was to walk around the block to get some fresh air/unwind and then come right back..

Do residents have offices? Or perhaps the right word is "call room" / "on-call room"? Where I can sleep once in a while?

If yes, I also can stay in hospital for an entire month or eleven. And I promise not go home, as there will be nothing to go back to. With the hours I will one day work as resident, no girlfriend. No apartment needed either, but I'll rent a climate-controlled storage room. Depending on how much stuff I accumulate by residency time, a room may cost $50- $200/Mo. Feasible plan?? No Rent! I want to use rent money to chip away student loans' interests.


P.S. Are there clean showers/baths at most hospitals?

 

[PostLessOne]

Technically, there's 165 hours in a week. If you were to sleep 7 hours a night, and to never leave the hospital...and shower/shave in 5 minutes, and to eat while 'working' (maybe gobble a protein bar or something every few hours)...you could work 119 hours a week. Pushing it above that means you have to cut into your sleep time...which even for a person who 'normally' sleeps only 5 hours a night is going to be hard to do. (since WS might be 'awake' 130 hours a week but she isn't actually working during all time)

By these numbers, 80 hours a week sounds like pure luxury! It's like surgical residents are prisoners, and thanks to new regulations they get to serve their time in a federal prison camp, minimum security. The old school attendings were locked in solitary at Alcatraz, and aren't too happy with the new way of things.

 

[Buzz Me]

Technically, there's 165 hours in a week. If you were to sleep 7 hours a night, and to never leave the hospital...and shower/shave in 5 minutes, and to eat while 'working' (maybe gobble a protein bar or something every few hours)...you could work 119 hours a week. Pushing it above that means you have to cut into your sleep time...which even for a person who 'normally' sleeps only 5 hours a night is going to be hard to do. (since WS might be 'awake' 130 hours a week but she isn't actually working during all time)

I'm a little confused. First, there are 24 x 7 = 168 hours per week. Next, if you sleep 7 hours a day, that's 49 hours a week, which does equate to 119 hours a week at work. But no one sleeps that long (at least, most residents I know don't). And you're assuming there's no call.

For example, take 4 am - 8 pm from Monday to Friday. That's 16 x 5 = 80 hours a week. Then let's say you work from 6 am - 1 pm on one of the weekend days, and have the other one off. Now you're up to 87 hours. And if you take home call two times that week (not bad at all), and come in for a total of 4 hours each time, now you're up to 95 hours. More realistically, let's say you additionally have to stay later (until 10 pm) on two of your workdays, plus have home call three times that week. That's 95 + 4 + 4 = 103 hours.

So as you can see, it's not that hard to go above 100 hours. Of course, reaching 120-130 takes some overnight "home" calls, leaving work later, etc. See my above post.

 

[Buzz Me]

Yeah he loved it too, although was a bit dismayed that I took 1/3 of the dose he took and he felt no effect.

It really was sort of scary in retrospect because I felt *so* good - alive, energetic, sexy - a superhero with none of the side effects of No-Doz: no shakes, no being awake but still feeling tired. It was like I imagine meth would be like.

And now you understand why DARE is in business.

 

[Shoushu]

Technically, there's 165 hours in a week. If you were to sleep 7 hours a night, and to never leave the hospital...and shower/shave in 5 minutes, and to eat while 'working' (maybe gobble a protein bar or something every few hours)...you could work 119 hours a week. Pushing it above that means you have to cut into your sleep time...

No, there're 168 hours in a week; not a 165! So your plan yields more free hours, time when you can watch a movie, chat at SDN, chat w/ the Janitor, chat w/ security guards, or read textbooks.

I only need to sleep 6 hours, and by the time I reach residency age, I bet I'll need slightly less sleep, probably okay on 4 to 5 hours per night. I need at least 20 minutes to shower and shave. Hopefully whatever hospital has nice shower and locker (I gotta be able to lock up some valuables right? I'd trust fellow residents but... ).

Problem is, Can I get 5 hours of uninterrupted, deep sleep at a hospital setting? A few posts above, I said I plan to not rent apartment for 5 years, but check out a long term climate-controlled room at U-Haul Self-Storage. If only I didn't have too many books/clothing, I'd prefer live out of my car. Residents get free parking??

 

[Winged Scapula]

My psych professor told us about it. Provigil is expensive. WS et. al, How did you get it? $7 to $10 per 200mg pill. Each 200mg can keep one awake 36 hours easily, as its half-life is 18 hours. I suppose you can ask other doctors to write you a prescription, or are docs allowed to diagnose themselves with Excessive Sleep Disorder?

As I recall, my ex got a few to try before taking his boards since he was having trouble with the hours of fellowship and needing to study. He wanted me to stay up one night with him to study so I took 1/2 of a 100 mg tab. I think he got a script from a friend.

I'm sure you are "allowed" to diagnose yourself with anything you want, but I'd be VERY careful about prescribing myself anything close to Provigil, if a pharmacy even filled it (if written by me).

 

[Winged Scapula]

FYI: yes, residency does cut into one's sleep.

It would be naive to think that you will sleep in your own bed every night for 8 hours as a surgical resident. After leaving work, you still have laundry, cooking, shopping, visiting friends, exercise, studying, cleaning...LIFE to do and most residents decide to give up a little sleep to do so.

 

[Apollyon]

And now you understand why DARE is in business.

You know what "D.A.R.E." stands for? No, not what you're thinking. It's "Drugs Are Really Excellent".

Police really REALLY hate it when you say that.

 

[Buzz Me]

You know what "D.A.R.E." stands for? No, not what you're thinking. It's "Drugs Are Really Excellent".

Police really REALLY hate it when you say that.

 

[PostLessOne]

It isn't a good idea to prescribe yourself a scheduled controlled substance. Provigil is on the federal 'scheduling' list of drugs that have abuse potential. (the 'schedule' is how much prison time you get if the government decides you are using/possessing/prescribing the drug improperly)

However, I've always thought that if you went to a psychiatrist or a primary care doc and said "I think I have shift work sleep disorder, and I'd like a script for modafinal/provigil". He/she would say "why do you think you have this illness". You'd say "I'm a med student on surgery rotation/I'm a surgical resident".

Doc would be like "Great Scott! Why didn't you say so in the first place! Here's your script. Unlimited refills. Come back in 3 months for follow up."

 

[Shoushu]

By these numbers, 80 hours a week sounds like pure luxury! It's like surgical residents are prisoners, and thanks to new regulations they get to serve their time in a federal prison camp, minimum security. The old school attendings were locked in solitary at Alcatraz, and aren't too happy with the new way of things.

You're right. I understand the Historical root of the word "resident", ah indeed, the residents decades ago, were all basically chained to hospitals 24/7. So their only place in life was at the hospital?

Our generation'll indeed be like in a minimum security Club Fed, high corporate type, white boy's jail. Can even wander off the hospital grounds and have our own abodes if we wish. I still think one can survive without renting out an apartment or house. The reasons are in my posts above. As I think more, one doesn't even need a room at Uhaul Self-Storage. Just live out of the car, on the parking lot paid for you, if residents get free parking.

 

[Guile]

You're right. I understand the Historical root of the word "resident", ah indeed, the residents decades ago, were all basically chained to hospitals 24/7. So their only place in life was at the hospital?

Our generation'll indeed be like in a minimum security Club Fed, high corporate type, white boy's jail. Can even wander off the hospital grounds and have our own abodes if we wish. I still think one can survive without renting out an apartment or house. The reasons are in my posts above. As I think more, one doesn't even need a room at Uhaul Self-Storage. Just live out of the car, on the parking lot paid for you, if residents get free parking.

One of my attendings trained at Hopkins (granted, a medicine attending) and said that even though he pretty much lived at the hospital he still got about 8 hours a sleep/night because they would just admit a patient when it was their turn and then once they got him tucked in they could eat, sleep, take care of their other patients, etc.

wrt to your not having an apartment, there's a lot to be said about having a home. I assume most of what you're saying is speaking hypothetically, but still. I couldn't imagine having my own place, even if I only sleep and eat in it.

 

[PostLessOne]

You're not the only one who's thought about this. I bet you could pick up some old clunker of a van...you know, the old utility vans with no windows in the back that are stereotypically used by rapists and criminals.

Anyways, you'd park that van somewhere and sleep in the back of it on nights when the hospital won't let you sleep there. Take all your showers and use the toilet at the hospital, and keep all your stuff in a storage garage. Alas, I think the climate controlled storage facilities (the ones that are air conditioned) are made in such a way that it would be difficult to use it as a place to sleep. It would save a lot of money.

OTOH, it might be a better idea to pay a friend a few bucks in return for limited couch privileges every month or something. Or, really, a room in an old house like on Grey's Anatomy might not be too expensive. Shame you wouldn't end up with 2 female roomates who would have sex with you and make you brownies like George gets to enjoy during the show.

But in general, time is your real problem. As a resident, you'll have about ~3k a month after taxes to pay your expenses. The reason not to go home very often is to save time, not because of the cost of having an apartment.

 

[WentForitandWon]

I think all of us on the cusp of matching into surgery are both excited and slightly terrified. Attrition is highest in surgery of all fields, and you have to think that very few people start a GS residency ambivalent about their career choice. In short, the quitters and the stick-to-it'ers are basically undifferentiated at this point. How can we know for sure we're not quitters?

I've read all of the pubmed indexed articles on attrition out of surgical residencies. It's quite interesting: the consensus seems to be that you can indeed identify factors that predispose people to switch, before they even step foot in the door.

The national rate of attrition is 2% per year, or between 20-25% total (meaning 1/5 to 1/4 of the people who start a categorical surgery residency won't complete it). Most quit before PGY-3 (more in PGY-2 than in internship).

Disaggregating the stats is even more interesting.

UTSW, for example found (http://www.ncbi.nlm.nih.gov/pubmed/18645106) that they lost 35% of their female residents, but only 22% of their males; that age over 29 was strongly correlated with quitting; and that participation in team sports in college was correlated with success. Most interestingly, academic factors-- such as performance in med school or placement on the final rank list-- was not significantly associated with quitting. And minority residents quit less frequently than whites/Asians.

Yale (http://www.ncbi.nlm.nih.gov/pubmed/19178898) was even bleaker for females: 40% quit, versus 25% for men. Being married, surprisingly, was protective against quitting-- presumably because single residents lack the same support system, and might be more depressed about their inability to date or find a spouse due to time constraints.

Emory had similar, though slightly more encouraging stats: 13% of male residents quit, versus 27% of females. (http://www.ncbi.nlm.nih.gov/pubmed/15708164)

And KU-Wichita found that, if anything, resident attrition has worsened since the implementation of the 80-hr work week. (http://www.ncbi.nlm.nih.gov/pubmed/18005766)

Finally, in the editorial comments sections accompanying many of these articles, authors mentioned that "personality characteristics" were most predictive of success, though no program administered personality testing to its residents to identify specific successful traits.

So my question for all of the residents and attendings here is: I'm sure most of you have had colleagues quit. Do you feel you could pick them out early on? Do you believe that 80% of success is simply showing up? And lastly-- to match into surgery you need to have done a third year clerkship (and liked it), plus multiple months in 4th year on surgical services. The lifestyle constraints shouldn't come as a shock, right? Do you think we 4th year students *can* have an accurate picture of what our lives will be like?

(In the spirit of full disclosure I'm a little freaked out about this data because I'm both female and over 29, so by dint of logic no surgical program should have accepted me over a 25-yo ex-rugby playing dude, right?).

I'm late to the table on this discussion, but I had to chuckle when I read your last line.

All the best from this 27 year old male, engaged, 1/2 latino, ex-outside center, first-year surgical resident .

I hope your signature line indicates the match turned out well for you.

 

[Buzz Me]

Yeah she did fine.

 

[MossPoh]

One of my attendings trained at Hopkins (granted, a medicine attending) and said that even though he pretty much lived at the hospital he still got about 8 hours a sleep/night because they would just admit a patient when it was their turn and then once they got him tucked in they could eat, sleep, take care of their other patients, etc.

wrt to your not having an apartment, there's a lot to be said about having a home. I assume most of what you're saying is speaking hypothetically, but still. I couldn't imagine having my own place, even if I only sleep and eat in it.

The term "resident" came around for a reason...I still have a hard time believing any human being could be a resident, do standard life maintainence and still get a solid 8 hours. Even with shortcuts.

In addition to many students not being used to the grind now, they also seem to enter medical school with a different fluffier concept of medicine. I'm sure there would be far fewer med school applicants by simply requiring them to do their happy little shadowing for more than a couple hours a day and without eliminating the boring stuff.

I still remember my dad telling me how he had his wife at the time swing my brother and sister by the hospital for a few minutes, just so he could see them. This was 1964 Bronx internship days, but still, people did and still do go through ridiculous hours. All about the BS tolerance.....and maybe a bit of stubborness and masochism thrown in for good measure.

 

[Guile]

The term "resident" came around for a reason...I still have a hard time believing any human being could be a resident, do standard life maintainence and still get a solid 8 hours. Even with shortcuts.

In addition to many students not being used to the grind now, they also seem to enter medical school with a different fluffier concept of medicine. I'm sure there would be far fewer med school applicants by simply requiring them to do their happy little shadowing for more than a couple hours a day and without eliminating the boring stuff.

I still remember my dad telling me how he had his wife at the time swing my brother and sister by the hospital for a few minutes, just so he could see them. This was 1964 Bronx internship days, but still, people did and still do go through ridiculous hours. All about the BS tolerance.....and maybe a bit of stubborness and masochism thrown in for good measure.

He was able to do it because he was just that: a resident. He didn't leave the hospital for six weeks at a time.

 

[PostLessOne]

Rumor has it back in the day there wasn't necessarily as much 'work' to do, per say. You might be awake and in the hospital for 120 hours a week, living there as a resident. But, in the 60s and 70s there might have been a lot more downtime and fewer patients per doctor assigned. Also, there were more hospital beds, and patients would stay a lot longer in the hospital so there wasn't a frenetic rush to get them discharged.

Patients didn't have every test and lab under the sun performed on them, either. So if you have fewer patients, less tests to do on each one, less paperwork stuff (there was no HIPAA and far fewer lawsuits) to write....

Oh, and nurses were tons more respectful to doctors, and probably paged them less often for trivial stuff. Heck, they didn't have pagers. At all. Must have used intercoms instead.

Maybe you lived there, and were a resident, but I bet during some of those 120 hours per week you'd have your feet up on something watching a little TV or otherwise relaxing.

 

[Guile]

Rumor has it back in the day there wasn't necessarily as much 'work' to do, per say. You might be awake and in the hospital for 120 hours a week, living there as a resident. But, in the 60s and 70s there might have been a lot more downtime and fewer patients per doctor assigned. Also, there were more hospital beds, and patients would stay a lot longer in the hospital so there wasn't a frenetic rush to get them discharged.

Patients didn't have every test and lab under the sun performed on them, either. So if you have fewer patients, less tests to do on each one, less paperwork stuff (there was no HIPAA and far fewer lawsuits) to write....

Oh, and nurses were tons more respectful to doctors, and probably paged them less often for trivial stuff. Heck, they didn't have pagers. At all. Must have used intercoms instead.

Maybe you lived there, and were a resident, but I bet during some of those 120 hours per week you'd have your feet up on something watching a little TV or otherwise relaxing.

Yeah there was a lot more drinking whiskey and chasing tail going on. (seriously)

 

[45408]

Rumor has it back in the day there wasn't necessarily as much 'work' to do, per say. You might be awake and in the hospital for 120 hours a week, living there as a resident. But, in the 60s and 70s there might have been a lot more downtime and fewer patients per doctor assigned. Also, there were more hospital beds, and patients would stay a lot longer in the hospital so there wasn't a frenetic rush to get them discharged.

Didn't patients used to stay for 4-5 days after an appy? I think an MI got you 2-3 weeks of in-patient bed rest.

 

[blue2000]

I think in someways it's impossible to compare. On the one hand, our chiefs used to be Q2 in house at our trauma hospital, which sounds terrible to me. On the other, at that time, there were 20 ICU beds in the whole hospital (now there are over 100) there were no fixed wings or helicoptors bringing people in from other states, etc. Our trauma teams usually run a census between 40-60 depending on the season; when I told that to one of the surgeons who used to attend there 15 year agos the volume was unfathomable to him. I think they actually slept a lot at night, where as the call room bed that the 4 chiefs share often goes days if not weeks without being slept in. I wouldn't trade -- there is no way I could manage a marriage and a child with the number of hours they were required to work in house. On the otherhand, I think that our 80 hours week is a little different than theirs.

 

[Winged Scapula]

You guys act like 120 hour weeks existed *only* decades ago and isn't a thing of recent times. I might remind you that the ACGME work hour rules came about in 2003; a mere 7 years ago. You're making me feel old.

Some of us on this board were in training then and can verify that while not all 120 hours were a mad rush from one thing to another (just as the 80 hours now is not) I can tell you that the census was still high, that the choppers were still dropping patients off, patients did not stay 4-5 days after an appy and we didn't have a coterie of PAs, NPs, and other mid-levels to do a lot of the work (which became the norm at many places after work hour regulations.

Is the acuity higher now than it was 30 years ago? Sure...most modern day ICU patients would have been dead in your father's generation. But let's not assume the good old days were THAT long ago.

 

[Svidrillion]

You guys act like 120 hour weeks existed *only* decades ago and isn't a thing of recent times. I might remind you that the ACGME work hour rules came about in 2003; a mere 7 years ago. You're making me feel old.

Some of us on this board were in training then and can verify that while not all 120 hours were a mad rush from one thing to another (just as the 80 hours now is not) I can tell you that the census was still high, that the choppers were still dropping patients off, patients did not stay 4-5 days after an appy and we didn't have a coterie of PAs, NPs, and other mid-levels to do a lot of the work (which became the norm at many places after work hour regulations.

Is the acuity higher now than it was 30 years ago? Sure...most modern day ICU patients would have been dead in your father's generation. But let's not assume the good old days were THAT long ago.

Perhaps this is why things came to a head and the 80-hour work week was put into place. In the "good old days" in-house hospital time was long, but the work load less. When the active work load began to match the actual time in house, folks realized that something had to change.

On that theory, the residents working in the early aughts just before the 80-hour work week were the most hardcore of all.

 

[Winged Scapula]

Perhaps this is why things came to a head and the 80-hour work week was put into place. In the "good old days" in-house hospital time was long, but the work load less. When the active work load began to match the actual time in house, folks realized that something had to change.

Perhaps, although the changes started to be talked about after Libby Zion's death in 1984. In hindsight, her death was probably more attributable to her drug use (and concealment of that fact) rather than an overworked and overtired intern treating her, but her well connected father made the case that the work hours and lack of supervision was to blame. NY State and the Bell Commission enacted regulations in that state in 1989 (which were well known to be widely violated). It took the ACGME and RRC many more years before the current regulations were put into place.

I'm not sure, at least in terms of many surgical programs, that any sort of realization came into play. Surgical programs frankly, IMHO, shot themselves in the foot with regard to work hours. If they had voluntarily reduced work hours, it may have been the case that they could have gotten by with more than 80 hours, instead of having it foisted on them. It didn't matter that every year residents were getting into car accidents post call, and some dying, or that patients and the general public complained about the work hours (if they knew...and most didn't).

It wasn't until the new ACGME rules came down the pike and surgical programs realized that surgical residents had changed, that the real changes started. Residents were no longer willing to give up their life for their training and many had no problem "whistleblowing" about work hour violations, especially off service and non-surgical residents. The arrogance that many programs exhibited, and still exhibit, was a barrier to change.

So I'm not sure that surgical programs, or any residencies for that matter, made changes because they recognized that patient acuity and workload was up. Rather I think they were forced into it against their will; some have done well with it and others have not.

On that theory, the residents working in the early aughts just before the 80-hour work week were the most hardcore of all.

I'll let others be the judge of that. I simply wanted to remind those posting here that the regulations are relatively new and its not like we were sitting around twiddling our thumbs watching low acuity patients in the early naughts.

 

[45408]

You guys act like 120 hour weeks existed *only* decades ago and isn't a thing of recent times. I might remind you that the ACGME work hour rules came about in 2003; a mere 7 years ago. You're making me feel old.

Come hang out at the VA. You'd be a "young lady" over here with these guys. Nearly every other patient here seems to comment on my age (lack thereof) at some point.

 

[Winged Scapula]

Come hang out at the VA. You'd be a "young lady" over here with these guys. Nearly every other patient here seems to comment on my age (lack thereof) at some point.

Ahh...yes, the VA. Where even the old and ugly are made to feel young and beautiful.

I get that here anyway since my office borders a large retirement community (and I look young for my age).

 

[Pilot Doc]

I'll let others be the judge of that. I simply wanted to remind those posting here that the regulations are relatively new

And there are, in fact, a very few surgery chiefs still around who did pre-80 hour internships.

 

[Guile]

And there are, in fact, a very few surgery chiefs still around who did pre-80 hour internships.

A few. The ones who did 2 years of research would have done their internship in 2002.

 

[SLUser11]

And there are, in fact, a very few surgery chiefs still around who did pre-80 hour internships.

It took them awhile to get to the top of that pyramid.

 

[JackADeli]

And there are, in fact, a very few surgery chiefs still around who did pre-80 hour internships.

It took them awhile to get to the top of that pyramid.

must be talking "chief of surgery".. attendings

 

[blue2000]

Actually, one of my co-chiefs did three years of research...was in the last intern class pre80 hour work week.

 

[Rabbit Hole]

Ahh...yes, the VA. Where even the old and ugly are made to feel young and beautiful.

I get that here anyway since my office borders a large retirement community (and I look young for my age).

Ahhh... Sun City. I have never seen so many golf carts on the road, RV's in front of houses, and buffet restaurants in my life. This place is so massive it's considered a city.

Did you choose that location because your patients are elderly folk or because of some other reason? Was it an intimidating venture?.. considering the cost or owning/leasing, staff, and getting new patient referrals.

 

[Winged Scapula]

Ahhh... Sun City. I have never seen so many golf carts on the road, RV's in front of houses, and buffet restaurants in my life. This place is so massive it's considered a city.

The first time I saw street legal golf carts was a shocker, that's for sure.

Did you choose that location because your patients are elderly folk or because of some other reason? Was it an intimidating venture?.. considering the cost or owning/leasing, staff, and getting new patient referrals.

I joined an existing practice and actually I have a younger patient population than my partner - she used to have a practice in Sun City West and still draws from that area and she operates at Boswell (which I don't). SHE chose the location because it was unserved - no one doing breast in the West Valley. We were, until a few months ago, the only fellowship trained breast surgeons in town. I got some referrals from those that already referred to the practice but did have to go out and market myself.

 

[Rabbit Hole]

I joined an existing practice and actually I have a younger patient population than my partner - she used to have a practice in Sun City West and still draws from that area and she operates at Boswell (which I don't). SHE chose the location because it was unserved - no one doing breast in the West Valley. We were, until a few months ago, the only fellowship trained breast surgeons in town. I got some referrals from those that already referred to the practice but did have to go out and market myself.

Okay so as a private practice surgeon you do operations/invasive procedures at the hospital and follow-up visits/non-invasive procedures at your office? Does that mean you have to have some sort of contract with the hospital? I wish there was some sort of business/financial class for doctors.. even though I have a strong aversion towards numbers.

 

[Winged Scapula]

Okay so as a private practice surgeon you do operations/invasive procedures at the hospital and follow-up visits/non-invasive procedures at your office?

I have privileges at various local hospitals to do surgery and stereotactic biopsies. I do my own FNA, ultrasound guided biopsies and placement of brachytherapy catheters in the office and see new patients and follow-up.

Does that mean you have to have some sort of contract with the hospital?

No, I am not an employee of any hospital. I have applied for, and been granted privileges to admit and operate at hospitals. There is no agreement other than I abide by the medical staff rules.

 

[Rabbit Hole]

I have privileges at various local hospitals to do surgery and stereotactic biopsies. I do my own FNA, ultrasound guided biopsies and placement of brachytherapy catheters in the office and see new patients and follow-up.



No, I am not an employee of any hospital. I have applied for, and been granted privileges to admit and operate at hospitals. There is no agreement other than I abide by the medical staff rules.

I've always wondered about this as far as surgeons go. Good stuff, thanks for the info.

I still wish there was a class (on-line or otherwise).. Private Practice 101. Unless there is a conspiracy going on in order to keep doctors oppressed and dependent upon hospitals for work. It's time to rise up.

Just kidding, sorta.

 

[Guile]

You'll learn a lot in residency. Many surgical residencies have rotations at private practices.

Also it's not uncommon for physicians to be employees of hospitals. I've heard/read it's becoming increasingly common. WS et al. can weigh in on that though.

 

[Winged Scapula]

You'll learn a lot in residency. Many surgical residencies have rotations at private practices.

Actually you will most likely NOT learn about this in residency. I knew nothing about the details of private practice from residency even though we did a rotation with a local group.

Also it's not uncommon for physicians to be employees of hospitals. I've heard/read it's becoming increasingly common. WS et al. can weigh in on that though.

Not so much for surgeons. Most community hospitals only employ HOBS (hospital based specialties) and increasingly hospitalists. However, the vast majority of community hospitals have medical staff that is not hospital employed but in private practice.

 

[Rabbit Hole]

Anything is better than practicing out of the back of some rusty old van.

 

[JackADeli]

Anything is better than practicing out of the back of some rusty old van.

I actually knew a guy that dreamed and achieved creating a practice out of a conversion van.... not in surgery mind you.

 

[Moonglow]

I'm worked out of this one summer; it could be set up for urgent care:

 

[Guile]

LOVE it that Wilford Brimley is on the TV.

 

[SLUser11]

You'll learn a lot in residency. Many surgical residencies have rotations at private practices.

I wish this was true, but it's not. Residents are very seldom given the training necessary to deal with the business side of surgery. This is a huge deficit in our training, and we spend the majority of our time in residency blissfully in the dark on topics like coding, investments, etc.

Most general surgery residents will end up in private practice, and most of them will be relatively clueless when they get there.