Residencies Without Call?

Discussion in 'Clinical Rotations' started by Morgus, Aug 4, 2001.

  1. Morgus

    Morgus Junior Member

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    I understand that there are some MD or DO residencies available in medicine, psych or family practice that have reasonable hours per week with no call at all or home call. I couldn't find a way through AMA-FREIDA to search with "no call" as a parameter. Can someone give me some direct leads to such programs? Is there a website that lists such programs in a separate category?

    Thanks in advance,
    Dr. Morgus, MD
     
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  3. tussy

    tussy Senior Member

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    It's true that some residencies have less call than others. Most programs will have call during their internship year, but after that it's program specific. Programs with the least call would include: pathology and lab med, psychiatry, family medicine, etc. Those with the most call include: surgery and internal medicine.

    However, when you love what you're doing, call isn't that bad.

    "what's the worst thing about 1 in 2 call? You miss half of the good cases!"
     
  4. Winged Scapula

    Winged Scapula Cougariffic!
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    I have never seen a website which lists programs according to their call schedule. As tussy notes, the specialty is probably the most important variable as well as location and number of residents (the more you have, the less frequent your call).

    While call can be painful it is a great way to learn - especially if your senior is not readily available. It makes you think on your feet as well as ask for help if and when you need it. It still scares me but I've made it through 5 weeks of call so far and can see the benefits of it.
     
  5. GreatPumpkin

    GreatPumpkin Mystical Treatbringer

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    Call? What is that?

    :D ;)
     
  6. wooo

    wooo Senior Member

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    oh, that sarcastic little pumpkin!!!!!!!!!! :D :D :D :D
     
  7. commymommy

    commymommy *reformed commymommy*

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    I vote that calls should be reduced though...seriously! For residents/fellows that have families a surgical or IM call schedule can really be unbearable at times! There has been a lot of talk lately about errors made by residents because of sleep deprivation....automobile accidents by surgical residents who have been up for 40 hours, etc, etc...

    It may teach you to think fast on your feet...but I think that a code at 2pm is just as likely to do that...at 2am you are more likely to make a mistake....

    Having survived 7.5 years of residency/fellowship training with my husband I would say that a more humane residency schedule is a must! In Europe, physicians are unionized and ALL calls are PAID from internship year on! Residents aren't allowed to work the same number of hours as are demanded over here. Granted, the training period is longer...but it is better paid...and well worth the extension...There were times that I really regretted coming back to the US!!!

    Kristen
     
  8. Winged Scapula

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    Gloating are we? Its a VALUABLE lesson (or so I keep telling myself as I drag myself out of bed for 1 asinine page after another). :D

    Although I agree that call/work schedules should be modified, its JUST as hectic for us single types. We have things and people we want to spend time with as well...not just the married ones (not that I assumed you meant that Kristen...just wanted to say that).
     
  9. tussy

    tussy Senior Member

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    Our residency union just got us a new contract - it specifies that we are not allowed to do more than 1 in 4 call. Also, the union rep gets to go over all call schedules before they are distributed to make sure that nobody is being forced to do more than 1 in 4, so that individual residents don't have to complain. It's also in our contract that we are not to be working more than 28 consecutive hours, however that one hasn't been enforced so far (i did 36 hours last thurs/fri).
     
  10. commymommy

    commymommy *reformed commymommy*

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    Kimberly,

    Didn't mean that at all :D. Actually, a friend of mine started her Gen Surg residency at Geisinger (when it was Penn-State Geisinger) and quit after the first year to go into ER...she had met a boyfriend and didn't have the time/energy to date with her schedule and started saying "What if I 'do' decide that I want to have children after all"...it was a big thing for her to leave the field because it had been her dream since she could remember....

    Surgical call is crazy...for the attached and "unattached"

    Hope I redeemed myself there ;)

    Kris
     
  11. Morgus

    Morgus Junior Member

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    Thanks for all of the responses so far! I wish I had found this forum before now. Where I am, most residencies other than surgery have 1 in 3 call, and surgery has 1 in 2 for the PGY-1 and -2, never getting better than 1 in 3. I just can't survive that for 3 years or more.

    I'm highly motivated and love being a doctor, but when it's more than 24 hours at a stretch, I'm totally brain dead and not learning anyway. I've made incredible mistakes in that no man's land of hour 24 to hour 36. I've learned the most on rotations that were about 12 hours/day and had home call or no call, mainly because I functioned better and had time to read about what I was seeing.

    Also, I'm hearing through the grapevine that the Midwest, specifically Ohio, may have some of the most progressive programs with respect to hours and call. Can anyone verify this?
     
  12. Winged Scapula

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    Up until the last sentence I was jealous..."glad" to see that there is some justice in the world with regard to surgical residencies! No one here seems to be keeping an eye out for how many hours we work, at least it isn't apparent. :D
     
  13. Winged Scapula

    Winged Scapula Cougariffic!
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    Sure. I actually rethought my original post all morning thinking I probably sounded bitter and harsh. I'm just starting to date and its pretty difficult coordinating our call schedules, let alone finding time to ALSO see family and friends in the area.

    No need to redeem yourself. I was the one who probably worded her post inappropriately. Was your friend at Danville or here in Hershey?
     
  14. Winged Scapula

    Winged Scapula Cougariffic!
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    Q2 all throughout PGY1 and 2? That's insane!!!

    I've done a couple weeks of it and its pretty exhausting. I cannot imagine doing it for 2 years. As a matter of fact, I believe that to be against RRC rules. I believe that call must average out over a month of q3 (ie, if you have a q2 you must then have a q4 to compensate). If what you're describing is true, that program is in violation and in jeopardy of having their accreditation pulled (unless I'm missing something). We used to do q2 here on CT and all rotations were changed to q3 on average to bring us in line with RRC rules.

    Interesting...

    BTW, I don't know whether midwest programs are more lenient with call schedules. I imagine as a group they might be more so than East Coast programs and community programs also tend to be better.
     
  15. commymommy

    commymommy *reformed commymommy*

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    You didn't sound bitter...I think I expressed myself wrong...

    She was in Danville...my husband actually did his IM residency there when it was still Penn-State Geisinger...We almost went back after fellowship but decided against it at the last minute...although we are revisiting those thoughts again. Initially, Danville seemed like an out-of-the "real world" kind of place to live...but it turned out to be a wonderful community to live in....

    How do you like Hershey? Have you been to the Hershey Park yet???!!! (Lots of free samples ;) )
     
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  17. Winged Scapula

    Winged Scapula Cougariffic!
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    I'm quite happy here. I like the smaller town feel yet with the resources of Harrisburg. Everyone complains that there is nothing to do here - and I suppose there aren't hip clubs or coffee houses here in central PA. But then again, I'm from Fresno so my expectations weren't high! ;)

    Most everyone is really friendly, the hospital is nice with all the amenities you could want (except more meal cards) and I have a lovely apartment. I've been to Hershey Park once so far, taking my nephew who was up from Virginia, and am considering buying a season pass. I won't use it a lot, but at $99 it pays for itself after 5 visits over the year.

    Let me know if you decide to drop back into central PA! :D
     
  18. Devdas

    Devdas Senior Member

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    In Newyork city, many surgical programs have Q3 oncall.Next day after your call you leave the hospital campus after morning round.
    You have the whole post callday for you after getting some sleep.It is great!

    According to NYC rule no surgical resident stays in the hospital postcall.I think some programs do not stick to this rule.

    How about other surgical programs outside NYC? Do you get post call off? :confused:
     
  19. Future GI Guy

    Future GI Guy Hoo Hoo....

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  20. Technically, ER physicians are never on "call"
     
  21. kundun

    kundun Senior Member

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    ophthalmology has very little call if any even during residency
     
  22. Winged Scapula

    Winged Scapula Cougariffic!
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    Only on SICU here. Otherwise you stay the entire post-call day with everyone else. :eek:
     
  23. Devdas

    Devdas Senior Member

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    Hi Kimberli,

    Can I ask for "post-call" Pyjamas instead of "T-shirt" from SDN ?

    It is too bad... you have to stay in the hospital after call.Anyway,it is good for your training. :p
     
  24. Winged Scapula

    Winged Scapula Cougariffic!
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    Just become a surgical resident - we wear pyjamas all day long! While the green cotton is nice, I would prefer a nice soft flannel pair for those chilly winter evenings. I'll see what I can do about getting some SDN scrubs made up! ;)
     
  25. AJM

    AJM SDN Moderator
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    Oh no, Kimberli -- you reminded me about the cold winters over there! I'm looking mostly at East Coast residency programs, and forgot to take into account the *cold* weather. I've been pampered here in Cali -- maybe I need to reconsider my choices... ;)
     
  26. tussy

    tussy Senior Member

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    One of my fellow residents asked this question to our chief and was told "real surgeons don't leave early post-call!" We are technically supposed to be able to leave at noon on the post-call day, but in surgery this is rarely enforced.
     
  27. Winged Scapula

    Winged Scapula Cougariffic!
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    Nah...don't worry. Depending on your specialty, you may NEVER leave the hospital enough to worry about the cold weather. Seriously. I went weeks without seeing sunshine or complaining about the hot weather we were having here. It wasn't hot in the middle of the night when I came in (and was certainly dark) and it was relatively cool at 8-9 pm when I was leaving (when it was dark as well). I assume that I'll have little concern about being cold in the winter except for the occasional foray out to the car! :p
     
  28. AJM

    AJM SDN Moderator
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    And that's supposed to make me feel better? ;) :p
     
  29. Morgus

    Morgus Junior Member

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    What a lively forum! This would have made a lot of difference in my life if I had known about it before med school!

    Let me give you an idea of the attitudes about call in the teaching hospitals in Texas that I've rotated in. Call is indeed 1 in 2 for surgery residents in PGY-1 and -2, and is usually 1 in 3 for all others involving direct patient contact (excepting of course radiology, pathology).

    I KNOW THAT THIS IS ILLEGAL OR AGAINST REGULATIONS. BUT THE PROGRAMS LIE TO THE OVERSEERS. When the complaint about working hours plead by one of the med residents' unions to OSHA hit national and local TV news back in May, there was a pervasive whispered warning to all students and residents in my hospital to not bad mouth the institution they were in, lest they never progress in their careers. Residency and hospital directors were interviewed on local TV here, and had the gall to state that any crackdown by OSHA on overly long working hours would not affect their residents and programs, BECAUSE THEY ALREADY LIMITED WORKING HOURS TO EVEN SAFER LEVELS. What total BS! Funny how I remember a "36 hour stint" turning into 54 hours straight. I don't remember what I did or where I was, because I was 1/15 on the Glasgow, but I do remember how terrible it was. That was just a few months before that TV interview. I was itching to speak on camera, but I knew I'd be dead meat if I did.

    When I was a 3rd year student, I did an MBA type analysis of manpower and scheduling in the hospital I was in, and developed a system whereby no one would ever work more than 12 hours straight, and there would still be 1 day per week off per person, with more than adequate coverage round the clock. It did mean that some people were working only at night some of the time, but hell, wheh you've been doing 36 hour drills, what problem is that? My pineal gland doesn't even sync with day-night anymore. My chief surgical resident agreed that my "radical program would technically work". But then he told me "Never show this to anyone, because it'll be taken as a sign of weakness on your part, and you'll never get anywhere." He liked me, and didn't want me to have my reputation screwed.

    One final episode. At this same teaching hospital, there is a war going on between the General Surgery residents and the Orthopods. I have friends on both sides of the conflict. A couple of months ago, ortho was short 2 residents for ortho clinic (because these 2 were presenting a paper at a conference), and thus they had the hospital administrator draft 2 surgery residents for the clinic. The 2 poor surgeons had already pulled 36 hours, and thus were drooling on themselves, stumbling around, and performing pretty poorly in the clinic. The orthopods started hazing the surgeons about being "weak", and now a war has broken out between the two sets of residents. How absurd!

    I don't see how we can expect the system to change until all of us in it change first.

    Best regards to all,
    Dr. Morgus
     
  30. Winged Scapula

    Winged Scapula Cougariffic!
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    Better? Uhhhmmmm...no! Just reminding you that it might not make a difference! ;)
     
  31. Winged Scapula

    Winged Scapula Cougariffic!
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    A GCS of 1? :eek: You get at least 3 just for showing up! ;)
     
  32. Hannibal Gabriel

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    We had an outside hospital recently send us a patient when I was on ortho, and the outside ER doc informed us the patient had a GCS of 2. This was a source of great amusement to us all. We speculated that the patient might be one of the undead, such as a vampire or ghoul.
     
  33. droliver

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    Here at Louisville, we make very concientious efforts to let the interns or PGY-2's (who take the in house call on the private & specialty services)leave early post call for humane reasons on days where there is no clinic or required meetings.

    I can't speak for other programs, but there has been a focused effort here on decreasing the amount of time spent in the hospital by our junior officers. This has included getting rid of all rotations with Q2 call by next year, plans to move conferences to one day of the week, having PA's do some of the scutworks on the busiest services, eliminating some of the unneccessary meetings, & mandating days off (at least 2) per month (not just lip service to this goal, either).
     
  34. Firebird

    Firebird 1K Member

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    What else can I say? One of Kentucky's state mottos is "Education Pays". No, I'm serious.

    Since we are such a rural state, we have a bad reputation for being outdated. But if you live in Kentucky, you realize that we are arctually very open to change and modernization. I think this is because we want rid of our hillbilly stereotype. So in a lot of instances, we try to jump the gun, I think...to get ahead of the crowd...an effort to be perceived not as a farming state, but just as cutting-edge as the rest of the country.

    The changes in Louisville are just an example of KY doing things in a modern way. Of course the metropolitan areas of KY are much more attuned to that change, but the rural communities are working on it.
     
  35. GreatPumpkin

    GreatPumpkin Mystical Treatbringer

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    Wow! 2 whole days a month, don't go overboard. Sounds like you all need to do a lot more. If I was choosing a program I would stay away from you guys like the plague. One of these days working residents like slaves will backfire. Either the unions or a agency like the OSHA will put an end to it.
     
  36. Winged Scapula

    Winged Scapula Cougariffic!
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    Unfortunately GP, that "mandated" 2 days off a month is pretty standard (provided you get it), at least for Surgical programs. Its what we get too...its not too bad, except when you can't leave early post rounds and are still hanging around on a Saturday post call at 8 pm! :eek:
     
  37. droliver

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    GP,

    not to be catty, but unlike pathologists we require patient contact to learn, which you just can't do when your residency is 8 to 4 pm. The technical part of surgery alone takes thousands of hours of training to be competent (which is the easy part incidentally), but the lion's share of our time is involved in learning physiology, medicine, critical care, etc. You want your surgeon to be that broad-based & well trained, it's why surgeons are consulted so frequently for the sickest patients in community hospitals when no one can figure out what is wrong with them.

    Two full days off a month is pretty generous, notwithstanding the days when you finish at somewhat reasonable hours. It really can vary by which service your on( I've had months with 50 hour weeks with no call as well as months with Q2 inhouse call where you're up for close to 36 hours at a time routinely).
     
  38. daveshnave

    daveshnave Senior Member

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    Our very own Kimberli Cox is from Fresno? Having grown up in Modesto, I feel honored that our moderator shares with me my Central Valley roots... ;)

    Hope PGY-1 is going well... I'm considering surgery, and I've heard many horror stories of working 100-120 hours a week? I know this goes on at many institutions, but would you say that some people tend to overinflate these numbers at times (ie. including hours slept/napping at hospital, etc.). Also, are all the years of residency equally as bad or does it get better/worse as you go from year to year? Was your surgery clerkship in 3rd year med school a good indicator of what it's like, or not (I'm only a first-year now, so I haven't been through this)? Any advice appreciated.... thanks.
    -Dave
     
  39. GreatPumpkin

    GreatPumpkin Mystical Treatbringer

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    I wish my hours were from 8 to 4. But, after working 12 or 13 hour days during the week I am very happy to have the off most weekends. It allows me to spend time with my family and regain my senses for the next week. It also gives me time to read about the cases I have seen.

    I cannot believe that learning surgery requires that the doctors totally sacrifice their life to become competent. Granted you need to see patients, but you are taking quanity over quality. Not, being a surgeon maybe I just don't understand, but surgery does not seem to be any more mentally challenging than other specialties and most don't work hours like surgery. It seems to me to be just an money issue. If you make the residents do all the work you don't have to hire extra attendings, PAs and/or nurses.
     
  40. droliver

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    Rob,
    Again.... You cannot become a good surgeon in 5 years without working an obscene (to some people) amount of hours period. The clinical & technical skills you must acquire just cannot be realized by reading a book or studying copies of slides on your own time like in pathology.
     
  41. commymommy

    commymommy *reformed commymommy*

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    So here's a novel idea.....why not extend the period of residency for two years, increase the pay a bit to make it livable, reduce the cost of med school education in this country and give the residents some more family-friendly hours? Sure...you need the patient contact...why not go a couple of extra years and have family contact too ;)

    :eek:

    Kris
     
  42. droliver

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    Momofthree,

    several reasons that lengthening a residency to two years is impractical:

    1) It would be too expensive. At my program for instance with 8 residents a year. You would have to come up with an additional 16 salaried positions at a cost of 35-45K per person per year (close to $650K altogether) @ a time where a lot of university hospitals are already operating on large deficits.

    2) you would not be able to do research years without finishing in your mid 30's. The accrued interest on student loans would be devastating, as well as delaying two years of your financially productive years

    3) if you did subspecialty training it would add another 2-3 years on top of you residency, again delaying you career by two years and probably over $1 million dollars in salary during that period.

    I do not think that anyone who is doing surgery training would embrace your suggestion.
     
  43. Boo_Rad

    Boo_Rad Junior Member

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  44. Morgus

    Morgus Junior Member

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    Hello everyone!

    When I started this thread, I had no idea that it would go on to near record lengths. I'm flattered at the interest on all sides of the issues that I stirred up. I was just looking for an easy search mode for finding residency programs with the least call or no call. Little did I know. . .

    I must say that I do admire those who ARE capable of actually learning productively while on 36 hour call Q2-Q3, particularly a rare few of the superhuman surgeons that I've known (I'm not being sarcastic). I really wish that I could do those hours and be sharp and productive. However, most of us, and some surgeons included who privately confide in me, just AREN"T capable of reallly learning beyond 18 to 24 hours, and even that's stretching it.

    In hospitals that I have worked in, there is an express and absolute prohibition against any "doctoring while intoxicated", whether that be from alcohol or other controlled substances. I've now found a number of rigorously conducted studies that indicate that a normally rested person who then is kept awake once for 24 hours--for the first time, mind you--is physically and intellectually impaired to the equivalent of a blood alcohol level of 0.10 to 0.15. The study wasn't even run out to 36 hours, nor were any studies done on multiple repetitive sleep deprivation insults.

    It's ironic that getting drunk or high would result in dismissal, but failure to do the hours that result in similar or worse performance impairment would also result in dismissal. I also find it ironic that testing for illegal drugs in hospitals I'm familiar with concentrates on marijuana, benzos, barbituates, opiates, PCP and cocaine, WHILE OMITTING TESTS FOR AMPHETAMIMES. Can anyone read between the lines?

    I've long been an advocate of eliminating substance abuse tests, and instead using performance oriented tests. Several new tests developed in industry measure eye movements and the ability of eyes to track moving virtual images in virtual reality goggles. If you're drunk, high, OR TOO TIRED, you fail, regardless of the underlying causation. YOU FAIL BECAUSE YOU'RE INCOMPETENT!!! These tests have been adopted in heavy industry to reduce the accident rate due to impaired machinery operators, and are being considered by the FAA for pilots.

    How many of us could pass an eye tracking test after 24 hours--or worse yet, 36 to 42 hours? Hell, I'm blind at 36 hours anyway. If you can't pass that, I don't see how you can be learning complex eye-hand skills in delicate surgeries. Perhaps some of der Ubermensche can handle it. Most of us can't.

    Admittedly I'm not a surgeon and never will be--if I end up doing radiology somehow, I'll do everything I can to avoid interventional radiology, because I don't consider myself to have a fast enough learning curve with dexterity issues. I wish this weren't the case, because interventional rad is great money and job security, but I'm not going to try to fake it. But if I were going to do that, I would simply declare myself "not ready for prime time" when too tired, rather than **** up and kill someone.

    I must say that I like the approach that momofthree suggested. I don't think it would have to be mandatory for everyone. If someone really could do Q2-Q3 Call 36 and pass the eye tracking test and still be really sharp, let them do it. If someone can't, and is in a field primarily concerned with thinking and analysis rather than thinking WITH eye-hand skills, let them have a break. I think having options would be the name of the game. Why not something like a FLEX TIME OPTION, in which you finish a program based on a combination of total contact hours, milestones achieved, evaluations, and in-training and board certification exams. Why does everyone have to finish at the same time?

    Finally, a comment regarding funding for increased years of residency and increased staff. It is my understanding that the Federal Government pays each accredited residency program $155,000 per year to train each resident. My VA Hospital chief, a friend and professor, told me that. Out of that, we get $31,000 in Texas, more like $45,000 in the Northeast, etc. Sounds like the hospitals are "getting over" on the $110,000 minimum difference here. Couple that line of reasoning to the fact that SOMEONE--the government, some insurance company, some patient, tax writeoffs, etc.---SOMEONE is charging an average of $300 to $400 per hour (far more in surgeries---don't get me wrong--surgeries should be expensive) for our services--FOR WHICH WE ARE PAID $8 TO $12 PER HOUR. Man the oars, galley slaves.

    Somehow, I think the hospitals would just "get over" even better if it took fewer hours per year but longer years to finish.

    Bottom line, I hope the system begins to mutate to allow the flexibilities that I have mentioned--although I know that the fraternity hazing aspects of "goddamit, I had to do it, so goddamit, you're going to have to do it, too" are legion in number and ferocity. Also bottom line, the ultimate result should be that we all become gifted superstar doctors without losing our souls in the process.

    Dr. Morgus
     
  45. Jamier2

    Jamier2 SDN Hillbilly Moderator
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    Boy do I feel slow this morning! I was just about to ask you why the heck the FAA was considering heavy equipment operators as pilots. :eek: After reading again, I see that you obviously meant that the FAA is considering the test for pilots. :)
     
  46. Winged Scapula

    Winged Scapula Cougariffic!
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    Yep...not born and raised but went to HS in Hanford and am a mighty mighty Fresno State Bulldog! :D

    My surgery clerkship hinted at the hours, but we were often allowed to leave early and rarely worked the full weekend. I am NOT exaggerating when I say I work 115 hours a week.

    There are some nights on call when I get some sleep but in 2 months I have yet had time to take a nap during the day (or perhaps its just fear of being caught doing so by my seniors rather than work keeping me from it)and at least on Trauma, most nights I got no sleep at all and didn't leave early post-call (ie, I worked about 40 hours or so straight). The hours will vary from rotation to rotation - for example, I just started Vascular today - didn't have to come in until 6 am (instead of the 4-430 am on other services)and won't have to respond to Traumas unless its after 6 pm and I'm on call. I am sure some do exaggerate and don't include naps or the few hours of sleep they might get on call. I think the first two months were particularly hard on me because I didn't get to go home early, so I felt like I could never get rested - I rarely had 8 hours off between leaving the hospital and having to go back again - less than 8 hours to sleep, eat, wash clothes, call family, etc.

    OTOH, I think I might be getting used to it. I got 6 hours of sleep on Thursday night and I was more tired yesterday than I had been on Thursday when I was post-call (and without any sleep at all). Perhaps my body is adjusting to the lack of sleep. :eek:
     
  47. Winged Scapula

    Winged Scapula Cougariffic!
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    Sounds like training in other parts of the world, eh? ;) Most US surgeons I've talked to do not care for your suggestion; only in commonwealth countries where this type of training is the norm is the US system seen as crazy. If you eliminated the great cost of attending medical school in the US, you would potentially clear at least one hurdle of incruing debt during residency. But I don't see any of this happening in the foreseeable future.
     
  48. GreatPumpkin

    GreatPumpkin Mystical Treatbringer

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    Kim at 115 hours a week, you are getting paid the equivalent of $4.60 an hour. And, by gosh you are worth every cent. :)

    And, now you wonder why institutions like to work residents these types of hours. And, to make matters worse they get money from the Federal Goverment to cover the salaries of the residents and then some. :eek:

    If they had to pay residents by the hour at the nurse pay scale. I bet you would see how good at training docs during reasonable hours these programs would become.
     
  49. Morgus

    Morgus Junior Member

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    Great Pumpkin,

    Thank you for pointing out that my estimate of residents getting the equivalent pay of $8 to $12 per hour was a grossly inflated figure, based on a much shorter work hour per week basis than that which you elucidated. I suppose $4 to $5 per hour is more like it.

    By the way, Halloween is my favorite holiday, and you have definitely made a friend through your name and comments here.

    And now to my favorite cybercrush I've never met, Kimberli, who I think the world of--but I must quote you to point out the "One Flew Over The Cuckoo's Nest" nature of things here:

    Only in the asylum do patients see the sane world as insane, and vice versa. I believe we are on the track of both delusional and dissociative disorders here.

    I think I'm going to suggest to OSHA that they start using the eye tracking test to measure competence. I know I'd flunk at 18 hours. How about you?

    Again, to der Ubermensche who really can handle the 120 hours per week and thrive, you have my undying admiration--I wish I were like you. But most of us are not.

    Best to all,
    Dr. Morgus
     
  50. commymommy

    commymommy *reformed commymommy*

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    Well, like I said...in order to embrace this idea, we would have to be willing to commit to some change in attitudes :eek: and I don't ever see that happening....I think sometimes people are either afraid to change or are just content being miserable :D . (provoke, provoke, provoke...this could be a real post-padder for me :rolleyes: )

    My husband is german and went to medical school and completed the first 18 mo of residency there. Medical School there is started out of high school..and is a 6 year program...4 years of basic science and two years of clinical "clerkships" that do not require call and are for the most part 9-5. The point is to be learning about differential diagnosis...following a few select cases and thinking through the pathophysiology, giving case reports, etc.

    For one year during med school, the students stop taking med school courses and focus on laboratory research (my hubby did neuroblastoma research)...the culmination of this is a thesis. This extends med school to 7 years. After the 7 years, a mandatory rotational year (PJ) is begun. This requires 4 months of IM, 4 months of surgery and 4 months of an elective. There is no overnight call in any field but surgery and that call is about once a week. The premise here is that working nights and days causes exhaustion....and that too many mistakes could be made...there is no difference in learning to think quickly on you feet at 3am or 3pm.

    After the 8 years are completed (at about the same time the US grads are graduating med school after 4 yrs of undergrad and 4 years of med school), the fun begins. Thomas began an 18 month internship "year" in oncology. Call was 4 times a year for a week of night float..where you came home and SLEPT in the morning....for reasons of physician health and patient safety! They do not let pilots fly more than a specifice, rather small, number of hours per month ... but a surgeon is allowed to take a patient's life into their hands after being up for 36 hours? Good GRIEF!
    Anyway.....the total length of time for residency is extended...for IM it is 6 years...I don't know what it is for the other specialties...

    Let me just say, that the US hospitals receive a little more than $100,000 annually for a resident.....that number is old (from 5 years ago)....Last time I checked, PGY1 salary wasn't even half that......Increase the percentage of the money given to the residents and quit paying all of the administrators as if they were God Himself...and you will afford physicians a better lifestyle during training.

    College education in this country is a whole other issue to be addressed...Tuitions are ridiculous for what you get....there should be a reform movement to DEMAND that the craziness end!!!!!!! We are preparing to begin our children's college funds and were told that the average cost of tuition when they get there will be approx. 400,000 for a bachelor's degree :eek: :eek: :eek: What is wrong with that picture?

    Med School should be free to all who are qualified enough to be accepted and the government should pick up the tab! Gosh, get rid of Clintons palace...errr I mean office in New York and you've got some extra mula!

    well, just thought I'd add a little fuel to the fire....but I know....what fun would residency be anymore if it was well-paid, the hours were reasonable and there was time for family and friends.......suffering is better! :rolleyes:

    hehehehe

    Kris
     
  51. Winged Scapula

    Winged Scapula Cougariffic!
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    Ugggh...thanks for clarifying that! ;)

    I LOL during orientation when they went over the pay scale; according to HR we make $17.70 an hour. Of course, this is based on a 40 hour work week! :D
     

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