Hae you seen the residency hours rules - you can average 80 hours over 4 weeks with an additional 8 hours per week at the programs discretion - so effectovely 88 hours over 4 weeks. Doesn't sound as humane as everyone thinks.
Residency Hours Regulation
- Thread starter 3more2go
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Don't know if you've ever talked with any of the older doc's about what residency was like for them. The reason that they are called "residents" is because they used to literally have to live in the hospital. Trust me, you won't get any sympathy from any of the senior physicians if you complain about 80 hrs. 80 hrs a week back then would have been one of their elective months.
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The 10% extension is not at the program's discretion. They must get permission from the RRC, which thus far has been difficult if not impossible to obtain. In Surgery, at least, any request for an hours extension will only be considered in the context of a full accreditation review.
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As ckent notes, 80 hours would be considered a vacation by some and it doesn't even have to be the "older" physicians. Even I, a lowly 3rd year resident, remember what it was like in the old days - 120-130+ hour weeks, no home early post-call, falling asleep in the OR because the post-call resident was given the "priviledge" of going to the OR to hold hook (while the others could possibly have some time to relax in the call room if the floor work was done).
80+ hours per week seems like nothing now.
80+ hours per week seems like nothing now.
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Don't forget though that in the days of our predecessors (I think I spelled that wrong), even though you were always on call, you rarely admitted more than 1-2 people in a 24-hour period, and generally the sicker people died bc they didn't have the high tech specialized health care that we have now. After you admitted someone, everyone else would have to get an admission before it came back to you. We also have large groups of patients that didn't used to exist: transplant patients and AIDS patients. Also, at least here in Baltimore, several smaller hospitals have closed in the last few years so the patients that used to go to other places now come to the larger academic centers.
So being on call all the time back in the day meant that you had an admission every now and then, and you had a large number of stable people on the floor (length of stay was much much longer). That being said, if you did have a patient who today would be in the unit, then there was no such thing, so you pretty much moved into their hosp room till they got better or they died.
There was no real need to divide it up into call days and non-call days because there just weren't that many admissions. Once the number of admissions started rising, they started dividing it up into call and non call days. Recently things have gotten worse. My program has been q4 call for at least 10 years. But even in the last 5-6 years, the average number of admissions on a call night has gone from 3 to 6.
So being on call all the time back in the day meant that you had an admission every now and then, and you had a large number of stable people on the floor (length of stay was much much longer). That being said, if you did have a patient who today would be in the unit, then there was no such thing, so you pretty much moved into their hosp room till they got better or they died.
There was no real need to divide it up into call days and non-call days because there just weren't that many admissions. Once the number of admissions started rising, they started dividing it up into call and non call days. Recently things have gotten worse. My program has been q4 call for at least 10 years. But even in the last 5-6 years, the average number of admissions on a call night has gone from 3 to 6.
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yeah, and in the good old days, when patients used to be able stay for 2 weeks without HMO's making a fuss, you have time to get to their medical history forward and backward, so rounding on them was way way simpler back then.
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Linie...
Is it really that way in medicine? I was always under the impression that there are fewer inpatients now than there were in the old days but that they tended to be the more chronically ill.
Perhaps that's just surgery. We do so many more things on a out-patient basis due to the explosion of laparoscopic procedures, better visiting nurses/social arrangements and the fact that we can't get funded for keeping patients for very long after most procedures - so we tend to have fewer inpatients and they stay for shorter periods of time than they used to. Patients that would have formerly been admitted are sent home with VNA, PO antibiotics and a follow-up in the office. Our nights are quieter than they used to be.
Is it really that way in medicine? I was always under the impression that there are fewer inpatients now than there were in the old days but that they tended to be the more chronically ill.
Perhaps that's just surgery. We do so many more things on a out-patient basis due to the explosion of laparoscopic procedures, better visiting nurses/social arrangements and the fact that we can't get funded for keeping patients for very long after most procedures - so we tend to have fewer inpatients and they stay for shorter periods of time than they used to. Patients that would have formerly been admitted are sent home with VNA, PO antibiotics and a follow-up in the office. Our nights are quieter than they used to be.
