Refusing to work more than 80 hours

[ArrogantSurgeon]

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I realize programs are required to abide by the 80 hour rule starting July. Yet there is rumor that some (or quite a few depending on who you ask) general surgery programs will not do so and instead will wait until they are formally warned by the RRC (in other words drag their feet and milk resident labor until they are officially notified that they will face consequences).

If I happen to match into one of these "noncompliant" programs next year, can I outright refuse to work more than 80 hours per week (or an average of 80 hours over a month) and use the new law to back me up? If I do so, can the hospital counter my refusal to work more than 80 hours with any legitimate reasons as to why I have to work more than 80 hours?

 

[MacGyver]

4 words: anonymous tip to the RRC

 

[maxheadroom]

1. I doubt that many programs are planning on violating the ACGME's new rules. Remember, it's 80 hours averaged over four weeks, so you might put in a 100 hour week from time to time. All of my friends say that their programs are pretty serious about complying with the new rules.

2. The 80 hour rule is a standard set by the ACGME. Several people keep refering to it as a "law", which is incorrect. There was a bill in Congress, but it was tabled when the ACGME enacted its rules.

3. Anonymous tips to the RRC sound like a bad idea. Never count on your tips remaining anonymous. If you have something to say, be a man and sign your name.

4. Tipping off the RRC is a good way to get into your colleagues' bad graces.

5. Tipping off the RRC is a good way to ensure that there is no residency program for you to complete.

6. Some violations will occur, just because it's going to take a while to get everything ironed out. While most programs seemed to be attempting to meet the rules starting this January, many will struggle for maybe a year to work out the details.

7. Don't be a baby. If you want to be a surgeon, accept the fact that you're going to have to work long hours. Accept the fact that doing the right thing for patient care may sometimes require you to stay later than you (or the ACGME) might desire. Please, don't bring your timecard-punching ass to my program. I'm here to work hard and I expect the same from you.

 

[apma77]

surgery is not a good field for u if u are worried bout hours and how they are enforced.
the general sattitude in surgery is to work your ass off and sacrifice most of the pleasures of life suring residency ; if you arent willing to do that you should look at more lifestyle appealing specialties like derm or radio

 

[Foxxy Cleopatra]

I think many programs are taking this quite seriously. Though like posted above, it is an average, so you will have some busier weeks followed by some easier ones.

I personally wouldn't report my program if they were not in compliance simply because I like it here and don't want to risk losing it. However, they are very adamant about making people leave the next morning if they were here all night even though some people would rather stay and follow the case through that they worked up while on call.

It is interesting to see how different programs are handling it- some alternate "busy weeks," others are taking call from home, some still take q3 call but have people leave the AM post-call, and some do night float.

 

[Cassidy61]

arrogantsurgeon- just remember that when you refuse to work past 80 hrs, you are only screwing your co-interns. the higher ups could give a flying leap who is actually doing the work, just as long as it gets done. if you were working with me and pulled that crap, i would give you a beat down! you cannot survive the residency process as an individual, so learning how to occasionally take one for the team is a necessity.

 

[vuillaume]

The most simple remedy to such a situation is not to rank a program that plans to violate the ACGME rules (and I've never heard of any programs intending to flout them).

Seriously though, I like to sleep and smell good as much as anyone, but the rules are a real pain in the kiester. I truly detest signing out crap that I couldn't finish myself.

 

[ArrogantSurgeon]

Originally posted by maxheadroom
Tipping off the RRC is a good way to ensure that there is no residency program for you to complete.

Yeah, that is why I was wondering if I can just tell let it be known from the start that I will not be working more than 80 hours per week (or an average of 80 hours over a month as some have said) and if the program can use any "policy" they may have to require me to work more than 80 hours?


If you want to be a surgeon, accept the fact that you're going to have to work long hours. Accept the fact that doing the right thing for patient care may sometimes require you to stay later than you (or the ACGME) might desire. Please, don't bring your timecard-punching ass to my program. I'm here to work hard and I expect the same from you.

Sorry I don't agree with this, as 80 hours per week is more than enough time to train to be a surgeon. Few other countries require trainees to work even these ridiculously long hours. Working hard is one thing, but being a virtual slave to your residency program is another. It may work fine for single guys/gals who have no family or outside interests apart from surgery, but those with children or other interests are seriously compromised by working 80 hours per week (e.g. the equivalent of 2 full-time jobs for 35-40K a year).

 

[tonem]

Probably the best time to let them know you won't be working more than 80 hours is during your interview so they have plenty of time to arrange your schedule.

 

[ArrogantSurgeon]

Originally posted by tonem
Probably the best time to let them know you won't be working more than 80 hours is during your interview so they have plenty of time to arrange your schedule.

😉

Nice try tonem, no way am I mentioning this stuff at the interview. I was thinking more like after I match into a program.

 

[eddieberetta]

It doesn't matter when you decide to tell your program, AS. It will mean the difference between not being ranked vs. being fired for "incompetence." If you really feel this way, it is time for you to consider being an arrogant-non-surgeon. There are plenty of arrogant internists, radiologists, dermatologists etc.

That's not to say that the 80 work week isn't a move in the right direction. It is just that your approach will engender much animosity.

 

[ArrogantSurgeon]

Originally posted by eddieberetta
It doesn't matter when you decide to tell your program, AS. It will mean the difference between not being ranked vs. being fired for "incompetence."

Can you elaborate on how they could possibly fire a resident for "incompetence" just because he/she refuses to work more than the regualtions allow? Is it a label they can falsely throw on residents if they want to get rid of them?

 

[eddieberetta]

Originally posted by ArrogantSurgeon
Is it a label they can falsely throw on residents if they want to get rid of them?

Yes.

I just watched the movie "adaptation" so I am in no mood to sort through pba's post. But I will say that although I agree in principle with his idea of telling people what you think strainght to their face, that does not work in certain circumstances.

Specifically, that strategy will backfire on you when you use it to shrug off work.

AS, I would recommend that you pick a program which already meets the 80 h work week restrictions. Unfortunately, in surgery, the only way you can figure it out is with electives (or asking your classmates -- you cannot ask the residents or PDs!!)

 

[ArrogantSurgeon]

Originally posted by pba
you can tell on whoever you want man. no one will stop you from lying at your interviews about how dedicated you are and then, in the event of a violation, ratting out your program. but i wouldnt want to work with you to be honest: you cant trust a rat, ever.

I never promoted the idea of telling the RRC if a program vioates the 80 hour rule. Some other poster suggested it, but I in fact said that I would like to tell the program itself. As another poster said, telling the RRC could possibly cause bigger problems for the program and may result in probation or loss of accredation.

fu#k it cuz i like being a slave to those patients. that's why i signed up for this bull$hit. because that's what i like to do more than anything else i have ever done.

Well that's the difference between those like you who live and breathe surgery and others who see surgery as only *part* of their life. I don't know if you're single or not, but if you ever have a family and kids you'd most likely think they were infinetly more important than surgery. And if surgery is the biggest thrill you've ever experienced then you haven't really lived.


i am a ***** for even writing this

I couldn't agree more.

 

[vuillaume]

I think--I hope--there are some fundamental values that we place above some arbitrary work-hour number. Above all is the patient. I'm positive that we'll all agree that "punching the clock" while a patient is unstable on the floor is incompatible with our professional creed. Second, is backing up your team, and more importantly, your fellow interns (if you're at that level). As I've said before, aside from issues that compromise patient care, nothing tee's me off more than having to sign out crap to a compadre. It makes me go home with a pit in my stomach.

An attitude that "I'm out the door the minute the big hand crosses the magic number" is not appropriate in a surgeon if she hopes to be well-regarded by her colleagues. And because the "operational tempo" of a surgical team is so accelerated, poor teamwork means inefficiency and possibly bad patient care.

I absolutely agree that the one greatest benefit of the ACGME rules is that they highlight time-consuming non-educational activities and will hopefully whittle these away over the next few years. But, as far as I'm concerned, this is the only good quality of the rules. I'd be fine with working 100+ hour weeks so long as we got that 24-hour hospital-free window.

 

[FireAway]

Anyone worried about punching their time card just doesn't get it. This is patient care. U wanna be a union worker like ur parents, then go do that, but don't show up in my residency program.

AS- Haha you really just don't have what it takes. Hiding behind your family like you do. You think the rest of us don't have lives outside of work? We do! Our families make sacrifices too, that's just part of the job. Anyone who can't handle that should do something else, anything else.

 

[apma77]

PAtient care doesnt mean you need to work 100+ hrs a week either. its only ONCE IN A WHILE that one is faced with a difficult patient situation vs. going home. So to say that wanting to work 80 hrs or less is anti- patient care is a bunch of BS. most of the time residents (juniors especially) are not saving lives in the trauma bay or ICU when its time to go home..they are doing meaningless scut work that could be done by ancillary staff

Ofcourse no good dr is going to leave a dying patients bedside to "punch out" but to say that 80 hrs or less will make some1 less of a physician is total BS!

 

[ArrogantSurgeon]

Originally posted by FireAway
AS- Haha you really just don't have what it takes. Hiding behind your family like you do. You think the rest of us don't have lives outside of work? We do! Our families make sacrifices too, that's just part of the job. Anyone who can't handle that should do something else, anything else.

Not hiding behind anything. However my family will always come before surgery, or any career for that matter...no doubt about that. I really don't know how anybody can have a productive family life while consistently working 100+ hours per week...no family should have to make such sacrifices so that daddy can go be a surgeon. I would never be going into surgery if this 80 hour rule was not in effect, and I will refuse to work more since every excess hour I'm in the hospital is taking away from my time and my family's. If that means "punching my card" and handing my patients off to another resident after 80 hours, then so be it.

 

[hemoccult]

I would never be going into surgery if this 80 hour rule was not in effect, and I will refuse to work more since every excess hour I'm in the hospital is taking away from my time and my family's. If that means "punching my card" and handing my patients off to another resident after 80 hours, then so be it.

Just for the sake of curiousity...what career choice would you make if the 80 hour work week limitation had not gone into effect?

I am not trying to be self-adorning or pious, but I feel that many others in addition to myself, would still choose surgery regardless of the work hour restrictions recently set into action. I had a feeling that the popularity of some of the more demanding specialties would increase with the 80 hour bit.

Another question, again not trying to instigate any angry response or suggest that your intent on entering surgery is founded on anything but sound decision-making and much thought, but why would you choose a demanding specialty such as surgery for your ultimate career choice if you despise the potentially arduous hours that must be put it to reach your end goal?

I know everyone wants to have their cake and eat it too (to be very cliche), but sometimes there is a bit of sacrifice and delayed gratification that needs be present prior to obtaining the ultimate reward.

...Just wanted to add some thoughts to this interesting thread...

Thanks🙂

 

[ArrogantSurgeon]

Surgery only became an option after I learned about the 80 hour rule, as there was no way I was going to be working 120+ hours a week. I don't care what anybody says, but you can't have a decent life by consistently working so many hours, and no way is it fair to your family to have you away for so long. I mean come on, there is an underlying reason why so many surgeons have poor family lives...you can't be there when you're working 120 hours a week. Also, I worked in a surgery lab all through undergrad and first two years of med school and got some pubs out of it, so I knew that would help when it came time to apply.

Don't get me wrong, I enjoy surgery, but I'm not all caught up in the surgical "culture" and all that jazz about being "proud" of working like a dog. Basically, I want to do what I have to while in the hospital and then just get home so that I can be with the family and do other things I enjoy outside of medicine. And I believe 80 hours a week is more than enough time to be training, if not still excessive. And after residency I knew there was always the option of tailoring your practice environment to satisfy your desires (e.g. part-time work, more focus on research, etc).

 

[LuckyMD2b]

AS -- I think that you make a good point. Personally, as a student working >80 hours/week seems unreasonable. (But, I think I'll be a man about it and suck it up)

However, no matter what you choose to do (surg, IM, investment banking, law), if you really want to be successful in your career and make a difference with your work you have to be willing to put in some extra hours on occassion.

Jeopardizing your patients' well being so that you can go home and chill, is inconsistent with what it truly means to be a physician.

--Lucky

PS A surgeon I did research for last summer told me: "Sure I like being at home with my family like everyone else, but after spending 4 hours with my kids I'm ready to go crazy. While I can be here for 10 hours and it's like nothing."

 

[Ace7]

This is a great debate. The problem I have with this problem is that people seem to leave out a very important piece of the puzzle. I think we can all agree that in the end we want the best for our patients and we are willing to sacrifice our lives including our families lives to that end. My problem with all of this is that nobody and I mean nobody talks about the human physiology regarding this issue. I mean for a group of people that are scientifically inclined we have missed the boat. While I understand that young residents want to be involved with their patients' care no matter if they have been in the hospital for 36 hours, there is a limit to what the body can take. At some point, and the research I have seen on the subject indicate the point can be as few as 10 hours of continuous work, your mental abilities will decrease. At this point are you really helping your patients or are you trying to show the other guys that you can stay up all night? If you have found a way to get around your bodies need for sleep I would love to hear about it. But the fact remains that there are limits to what you can do and the fact that you will lose your ability make sound critical judgments may not be in the best interest of your patients. Talk all you want about how you can tough it out, and I'm sure I'll be right there with you, but I feel the system is set up in such a way that patients ultimately suffer so our egos can be enlarged.

A

 

[daredevil_2010]

The days of working over 100 hours is over. And good riddance. There is no way one needs to work this long. I've seen enough residents "waste" 2-3 hours per day just sitting around wasting time... waiting for others. This is the tatamount of ineffiency.

This new rule forces programs to be efficient. Cut out the fat that
"Absolute" power seems to always allow to creep in.

The program I am at is very strict about these new 80 hours. We have to electronically log in our hours. Our schedule for the day is broken down into how many hours we can work. Our Program Director has told us flat out that is he finds out we're not logging in all our hours... our contract may be in jeopardy. Patient care does not have to suffer. Interns and Residents just need to be more efficient and have better communication skills. The day were a Resident, with his cavalier attitude, felt he could do all the work is gone. PAs and NPs are now doing all the "scut" work that used to occupy the Residents day.

I say if your program is not taking the 80 hours seriously... this is just a reflection of the arrogance of the program. Bad leadership. We all know what happened to Yale.

 

[ArrogantSurgeon]

daredevil, what program are you at if you don't mind sharing? This is the kind of stuff I'm talking about.

 

[daredevil_2010]

Arrogant,

email me and I'll tell my program: [email protected]

I feel like I'm at the best possible academic program. I interviewed at 14 schools and this one was one of the best. All the Attendings are super friendly.... even though many of them have trained at Duke, Emory, Stanford, MD Anderson, etc... The hospitals NIH funding continues to improve. new Research buildings are are almost done. A new hospital is about to start being constructed next year,

All the Residents are super friendly. All the chiefs are psyched about the new hours. Now they have a life! Heck, my chief just yelled at me today because I worked 30 minutes over my schedule. he told me "you gots ta go!"

Right now I'm doing one of the hardest rotation, yet I'm only q4. I get about 2-3 days off per week (2 for post call and one full day off a week). My chief just told me to take July 4th off as well... even though I'm scheduled to work that day.

The city the program is in is awesome too. One of the best!

 

[trauma_junky]

Hey, New York has had it on the books as a LAW since 1984. The whole NYU porgram is considered to be one of the best and they set the standard for 80 hour weeks 9 years ago. Who gives a flying F, I know the military did a study on sleep deprevation among infantry soldiers. Their accuracy did not change, but their acuity was deminished (friendly fires increased). This right of passage BS needs to end. It's just hazing on a different level.

 

[maxheadroom]

NYU is one of the best??? What are you smoking? Best surgery in NYC are Cornell and Columbia. If you work at NYU you have the glorious opportunity of being killed while you're on duty at Bellevue, like one of your predecessors back in 2001.

 

[trauma_junky]

Those of you that say family before surgery is a must, sacrifice before ultimate reward, yada yada yada. Here are some words you should get used to hearing: alimony, child support, custody, visitation, litigation, and therapy.

 

[daredevil_2010]

I've received a lot of emails asking what program I'm at. I guess I'll just tell you straight out. Maybe it will help some of the 4th year med students.

Before I tell... just one quick note: I'm not too sure if everybody is happy about the 80 hour work rule here. But when the Chairman and Program Director make it clear that the program will follow the 80 hour work rule and they electronically track the hours... people fall into line. All the chiefs seem realize their own benefits. NO ONE LIKES TO WORK LIKE A DOG.

The program and hospital I'm at is great. Tertiary care center. Level I Trauma... yadadada. However not many people have heard about it. I know as a student I never did until my Fellow told me about it. He said it was a "diamond in the rough". The city it is in is one of the best. Rated the 2nd friendliest city in the country. Also in 1998 led the country in House Appreciation. Land value increased 18% in one year! You know that means people are moving like heck here. Located right on the ocean. Many people love to go boating or to the beach, or spend the night in the historic downtown. several of us guys are thinking about buying a sailboat.

Well enough bragging. I feel very lucky to be here. Like I said I interviewed at 14 schools... so I got to see the very best (and worst). If you're a medical student I would seriously consider at least applying and interviewing here... just to see what I'm talking about.

Medical University of South Carolina (MUSC). Located in Charleston, South Carolina.

general web site: http://www.musc.edu

NIH funding rankings: http://grants1.nih.gov/grants/award/trends/medschc.htm

Best children's hospital in SouthEast US: http://www.child.com/kids/health_nutrition/top_hospitals03.jsp?page=12

MUSC's Surgery Department page: http://www.musc.edu/surgery/

 

[DD214_DOC]

Charleston rocks 🙂

 

[Airborne]

This is a very interesting thread and thought I'd add a bit - albeit my thoughts are from an MSIV, who is definitely not in the trenches.

I completely agree that if you are the only one to scream foul play, you will only hurt your fellow interns and higher ups. There is SO much to accomplish in medicine that we all truly have to look out for each other in order to get the work done. Oftentimes this means the MD is covering for ths RN, MSW, etc - and oftentimes they, in return, cannot cover for what you (as an MD) can provide (and me in another 10 months!) - but at the end of the day we all (hopefully) love medicine, and I would hope to think that an extra 5-10 hours is a small price to go home at the end of a week knowing that "I did what needed to be done" for my patients. Sure my wife and I are best friends - I would give ANYTHING to spend another 5-10 hours per week with her. At times, she absolutely despises my choice for a career, but I come home with tales that astound her, and she truly appreciates why I chose this career path - I couldn't imagine anything more fulfilling. Sure, as a PhD and soon to be MD/PhD, I could always go into research - but there is nothing like interaction with patients. Yes - I get frustrated with the innumerable Medicare/Medicaid patients who are, well - frustrating. But, I know that I currently, and only more so in the future, have an impact on their health, both medical and social. Yeah - maybe I or my colleagues do not prolong survival, but I am there to listen (albeit sometimes to my time constraints) to their issures and hopefully alleviate both pain and suffering.

Yes - I am the first to ackowledge that other countries do not have anywhere near the time commitment that we Americans have in our training. Sure, they have better ancillary staff, and whatever - but at the end of the day, we are training here. Sure things can change - eventually, but it will take a hell of a lot more that the current "recommendations" - perhaps those interested in such training should go overseas or wait out a good 5-10 years - I am sure it will be better then.

Unfortunately (or furtunately as the prospective/current intern may see) - the US is perhaps one of the most desireable places to train. Although we have our weaknesses, both in terms of hours and in terms of actually getting a place (unless you are from a US school) - in the end, many foreign trained physicians/surgeons would kill to be here.

Am I looking forward to next year (2004) as an intern - hell no. But then again, who does look forward to this? What I do know is that no matter where I go (hopefully) I will be trained well, continue to be empathic and hope that my wife continues to be supportive in what I consider a life's calling.

Sure I think that my peers without a family have it easier - but then again do they have someone to come home to to bitch about the day's events, relate the highs, and inevitable lows - Truly, this is a most unique journey, and come what may - I am quite enthusiastic and what comes ahead. And though times are long - I am happy to know that there is someone there to support me.

Airborne -

PS - I would keep my mouth shut about violations of the new 80 hour rule - it can only serve to hurt the "instigator" and your fellow interns - as well as increase the likelihood of failure for the level of training - but this is coming from an MSIV,

 

[daredevil_2010]

Originally posted by Airborne


Am I looking forward to next year (2004) as an intern - hell no. But then again, who does look forward to this? What I do know is that no matter where I go (hopefully) I will be trained well, continue to be empathic and hope that my wife continues to be supportive in what I consider a life's calling.

Do you think it gets easier after your intern year? Hahaha. It only gets harder!

Try being idealistic after working 120 hours for several months without a single day of vacation. Not too easy. A lot easier after a day off or two.

 

[ArrogantSurgeon]

Airborne,

I too have heard a lot about surgical residents in other countries working no where near the hours worked in the USA. For example, I was in the Netherlands a few years ago and found out that general surgery residents there work about 45-50 hours per week, and these hours were the same for much of the rest of Europe. Would you know what kind of system the hospitals in theses countries have in place to allow residents to work reasonable hours like this? Can the US learn from this and adopt similar measures?

 

[droliver]

For starters..... those countries have Universal Health Care which distributes patients in a different manor then the way indigent and Medicare/medicaid patients are funneled into the teaching hospitals. We do many elective procedures which are just not routinely performed or not done promptly in other countries which inflates the volume of procedures done. The medical education & training process in Europe & elsewhere is also decidely different from the way we compete for both medical school acceptance & training positions.

The style of medicine that in part allows those work hours would not be acceptable to Americans. In addition, the United States is pretty much recognized as having the overall (on a system basis) best trained surgeons in the world (Note: this does not imply that any indiviual surgeon from another country might not be a recognized expert in some given procedure) Aiming for the environment & subsequent quality produced by other countries would be a step backwards from what we have

 

[eddieberetta]

Yet interestingly, the unparallelled high spending and long hours put in by physicians in the US (and even Canada) has not translated into better health for the population as a whole (I'm especially talking about the US here).

 

[droliver]

eddie,

the failure to achieve better outcomes in health indices on that scale is more related to our more heterogenous population and the poor medical mgt. of chronic disease by internists, PCP's, & medical subspecialties then by any impact surgery can have on large populations of people.

 

[ArrogantSurgeon]

Originally posted by droliver
In addition, the United States is pretty much recognized as having the overall (on a system basis) best trained surgeons in the world (Note: this does not imply that any indiviual surgeon from another country might not be a recognized expert in some given procedure) Aiming for the environment & subsequent quality produced by other countries would be a step backwards from what we have

This is just your American arrogance speaking. The reason the US is regarded as the "best" is because of the technology and resources available to our surgeons, not because our surgeons have the best hand skills, diagnostic abilities, clinical judgement, fund of knowledge, etc. And that is why so many foreign surgeons come here to train...not to mention that surgeons here get paid a whole lot more than in other countries (which is a big attraction for foreign surgeons wanting to "jump ship" and work in America).

 

[droliver]

Originally posted by ArrogantSurgeon
This is just your American arrogance speaking. The reason the US is regarded as the "best" is because of the technology and resources available to our surgeons, not because our surgeons have the best hand skills, diagnostic abilities, clinical judgement, fund of knowledge, etc. And that is why so many foreign surgeons come here to train...not to mention that surgeons here get paid a whole lot more than in other countries (which is a big attraction for foreign surgeons wanting to "jump ship" and work in America).

My arrogance? 😕 You just echoed exactly what I said!!! WE HAVE (by consensus) THE BEST TRAINING SYSTEM IN THE WORLD (not the most efficient,holistic, or humane). Like I added, it doesn't imply that any individual US trained surgeon is superior to any given foreighn one, it just means the system as a whole produces a better product. The wealth & resultant technology of Western Medicine are a big part of this, as are the fairly strict standards of the field as compared to many countries.

 

[womansurg]

Originally posted by droliver
My arrogance? 😕 You just echoed exactly what I said!!! WE HAVE (by consensus) THE BEST TRAINING SYSTEM IN THE WORLD

Not exactly what AS said, which was this:

The reason the US is regarded as the "best" is because of the technology and resources available to our surgeons, not because our surgeons have the best hand skills, diagnostic abilities, clinical judgement, fund of knowledge, etc.

Not the same thing. If I have the best, fasted NASCAR in the world available to me because I am rich, that by no means makes me the best race car driver, in terms of ability and native talent. And driving that car in training doesn't mean that I received the 'best' training, by any means. I might be a clumsy, slow, inept driver, both in training and then professionally, even though I have access to the world's fasted car.

Studies have confirmed that US trained physicians sometimes lag behind their foreign trained counterparts in physical examination and diagnostic skills, in part because of our reliance upon technology. In other words, one could say that we have the faster cars but they are the better drivers.

 

[ArrogantSurgeon]

Thanks for making my point clearer womansurg.

Many people are under the false notion that just because lots of foreign surgeons come to the U.S. for additional training it means that our system must therefore have the "best" surgeons. We certainly have among the best technology and utilize the latest advancements from around the world, but it is a stretch to call our surgeons the "best" in and of themsleves.

Also, let us not forget that many surgeons that come here from overseas don't necessarily do so to improve their skills, but rather do so in order to improve the quality of their own lives and that of their families since job opportunities and income for surgeons here are relatively much better than what surgeons get in most other countries. It is no secret that a good portion of foreign surgeons who come to the USA for additional training (e.g. through non-accredited fellowships) under *temporary* visas will overstay those visas and try to set-up residency in the U.S. with the help of hospital sponsorship or by other means...and many are successful. That is one reason you have fully-qualified surgeons in their 30s and 40s from countries like India, Pakistan, China, etc studying to take the USMLE exam so that they can eventually practice in America.

 

[eddieberetta]

Originally posted by droliver
eddie,

the failure to achieve better outcomes in health indices on that scale is more related to our more heterogenous population and the poor medical mgt. of chronic disease by internists, PCP's, & medical subspecialties then by any impact surgery can have on large populations of people.

I see. So what is the basis for your assertion that the US has the best surgeons in the world?

 

[droliver]

Alright....one more time. We have the "best" training system which usually produces the best trained surgeons (NOT saying that anyone in particular is the "best" surgeon). We're the beneficiaries of the richest country in the world & are thus also likely to have access to technology, resources, & techniques in excess of or not available to some of our peers elsewhere.

Womansurg, I think a better analogy would be a child athlete in a highly skill dependent sport . If you take them & give them the best training, coaches, & equipment you usually (but not always)end up with the best product at the end. These kids may not be the best athlete (or potential surgeon in this case) but they've been given the best chance of succeeding at the highest level (in this case 21st century practice of surgery) vs. someone who didn't have access to it.

 

[daredevil_2010]

Developed countries like the US, England, and Japan have the best surgeons. They have access to the best technology and training facilities. They are surrounded by top caliber professors that continue to push them to higher limits.

Also, technology is the key. Forget about the physical diagnosis and other stuff. Physical diagnosis will be wrong far more times than a CT or MRI. Period. This is fact. A lot of people think using technology is a failing of a doctor. WRONG. Technology has allowed medicine to advance to levels people never thought possible.

In this day of age of legal lawsuits, if you didn't do a CT, CXR or whatever... and relied on Physical exam you can pretty much kiss your lawsuit goodbye.

 

[droliver]

Originally posted by daredevil_2010
Developed countries like the US, England, and Japan have the best surgeons. They have access to the best technology and training facilities. They are surrounded by top caliber professors that continue to push them to higher limits.

I agree in general. However, lots of brilliant surgeons & scores of innovations come from all over. For example: the Bogota Bag (and its equivalents) for abdominal trauma came from the experience of Columbian surgeons and abdominal GSW's during the Cocaine Wars in recent years. The Russians came up with anastamotic staplers, early wound VAC type devices, multiple orthopedic fixeter devices, and RK surgery. The Brazilians are some of the innovators in ventricular remodeling surgery & have one of the richest pedigrees for cosmetic surgery. Australia was one of the early adoptees of laparoscpic surgery & many contributions in cutaneous laser surgery. Japan sets the bar for hepatic & gastric malignancy surgery. The list goes on.....

 

[droliver]

Originally posted by eddieberetta
I see. So what is the basis for your assertion that the US has the best surgeons in the world?

Sorry I missed this one earlier Eddie....

My point being that out of a population of hundreds of millions, few will have surgical disease @ any point in time so you dilute out the relative benefits of surgery vs. those medical commorbidities which are much more prevalent. When you select subgroups within that large population out (ie. those with melanoma or breast CA) then you realize benfit from surgery among those groups without really changing the averages of the group as a whole much when the denominator is several hundred million people.

The basis for arguing that we have the best trained surgeons as a group is that we have a system (starting with medical school)that affords oppurtunities not available to most other countries as well. This is pretty well-recognized world-wide

 

[vuillaume]

It's going to take a while before programs figure out the bet way to deal with the new rules. Right now I suspect for many places, the day-to-day, minute-to-minute functions of surgical services are the same as they were last year; it's just that superimposed on that they send people home or rejigger hours so they meet the limits. This will inevitably be dysfunctional.

Key will be that programs really listen to their residents' feedback and ideas about how to adapt the operation of the services in the context of the new rules.

 

[daredevil_2010]

The new 80 hours seems to be working great for me. Two interns on the service plus a new PA. If you're post call... you pretty much go home by 9:00. The other intern and PA do the paper work.

Now my Chief wants me to come in at 7:30 during the day the other intern is on-call. Plus I have already scrubbed in some major cases.