Residency Program increasing hours... Some help.

[Emerg]

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Our residency program has decided that as residents in a 4 year EM program we don't work enough. We were told when applying that as 2-4 we would be working 14-8 hour shifts and 4-12 hour shifts. Now all the sudden they have increased the length(9 hours) and the number to 16-9 and 4-12s.

Is there a way to do anything about this? I am sure it is not written in our contract as to how many hours we work. They don't include required conference time, journal club or asynchronous learning in our hours.

What number of shifts and hours are other 4 year programs doing?

 

[GeneralVeers]

Unless the hours are stipulated in the contract you signed, and as long as the new schedule meets ACGME work hours guidelines there is nothing you can do.

 

[DrVanNostran]

I'm just surprised that that the username "Emerg" wasn't already taken 🙂

 

[CestaVie]

I honestly think it's ridiculous to make EM a 4 yr program and it's just another way for hospital/whoever to milk residents for cheap labor. But I'm in the mindset that med school can be cut to 3 yrs if we don't do time wasters like other electives... if you know what you want to do, why should you be forced to do rotations in other specialties? "It'll make you more well-rounded"... yeah right. I never wanted to do Geriatrics or OBGYN and could have cared less to have rotated through them during medical school. Having 2 weeks of OBGYN in residency is enough.

 

[RustedFox]

Agree w/ above. A lot.

Medical school *needs* to be streamlined. Biochem ? 6 weeks should be plenty, not a whole term. We don't need krebs cycle/ox phos for our third time since high-school. Embryology ? Pffft. Yep. That was REALLY useful. Histology, even - that can be seriously cut.

I've had this conversation with multiple people, and I've ran into my share of detractors who say things like - "you need to understand the... whatever." My point is: if things keep going the way they are, medical school will be six years long, cost a million dollars+, and won't be a reasonable option for anyone who isn't "from money".

 

[Apollyon]

Our residency program has decided that as residents in a 4 year EM program we don't work enough. We were told when applying that as 2-4 we would be working 14-8 hour shifts and 4-12 hour shifts. Now all the sudden they have increased the length(9 hours) and the number to 16-9 and 4-12s.

16 x 9 = 144. 4 x 12 = 48. 144 + 48 = 192. 192/4 = 48 hours/week. You could work even more (your 4 12's go up to 8 12's). Provided you're in an ACGME accredited program (not AOA - I don't know their regs), you aren't even working as much as some others (like St. John's in Detroit, or at least used to be).

 

[deleted65604]

Is there a way to do anything about this?

Suck it up and work.

 

[sleepymed]

Agree w/ above. A lot.

Medical school *needs* to be streamlined. Biochem ? 6 weeks should be plenty, not a whole term. We don't need krebs cycle/ox phos for our third time since high-school. Embryology ? Pffft. Yep. That was REALLY useful. Histology, even - that can be seriously cut.

I've had this conversation with multiple people, and I've ran into my share of detractors who say things like - "you need to understand the... whatever." My point is: if things keep going the way they are, medical school will be six years long, cost a million dollars+, and won't be a reasonable option for anyone who isn't "from money".

I disagree with this. Part of what makes us doctors is the level of training that we get; if we cut all that stuff out (Ob/Gyn, anatomy) then we become a PA school. The length of med school has been 4 years for at least 50 years, and has not gotten longer despite the increase in knowledge. Understanding about glutamate and NMDA really help you understand alcohol withdrawal and toxicology in general. knowing physiology really helps you grasp pathophysiology which helps you grasp the appropriate treatments better. skimming over things does not make for better doctors.

fyi -- the med school that is associated with my residency program just revamped its curriculum so that the curriculum matches what you described and cut out many "non-essential" months and the strength of the students that are rotating in the er has dropped significantly, they are lacking in their core knowledge, what makes things worse is that they are rotating with counterparts from the old curriculum and the difference is glaring. sadly my co-residents on other services have noticed the difference as well.

Furthermore, most people aren't dead set on what they want to do when they start med school, and you only realize that they love (or hate) a specialty after they rotate in it.

 

[Cerberus]

You aren't going to get much pity when your new hours are the same or less than what many of us work.

 

[SepulvedaMD]

I disagree with this. Part of what makes us doctors is the level of training that we get; if we cut all that stuff out (Ob/Gyn, anatomy) then we become a PA school. The length of med school has been 4 years for at least 50 years, and has not gotten longer despite the increase in knowledge. Understanding about glutamate and NMDA really help you understand alcohol withdrawal and toxicology in general. knowing physiology really helps you grasp pathophysiology which helps you grasp the appropriate treatments better. skimming over things does not make for better doctors.

fyi -- the med school that is associated with my residency program just revamped its curriculum so that the curriculum matches what you described and cut out many "non-essential" months and the strength of the students that are rotating in the er has dropped significantly, they are lacking in their core knowledge, what makes things worse is that they are rotating with counterparts from the old curriculum and the difference is glaring. sadly my co-residents on other services have noticed the difference as well.

Furthermore, most people aren't dead set on what they want to do when they start med school, and you only realize that they love (or hate) a specialty after they rotate in it.

Well stated. In fact, within my class I'd say half have no idea what they really want to do. I am a 3rd year BTW, with only 4 weeks left. The amount of work we put is exactly what separates us.

I agree that curriculums must adjust to the needs of the profession, but I fail to see how removing an entire year is the answer. As a 3rd year entering my 4th year, I am well aware that I am not ready to be a resident. I just don't know enough. To put me in charge of patient care on July 1 would be detrimental to the patient and incredibly stressful for me.

If we try to skip out on the basic science, we become nurses and PAs, beholden to algorithms. What makes you a physician is that you know why something happens, what causes a coagulopathy and why a specific treatment is or isn't indicated.

Med school can be a drag. Its long, the work is constant, and the prestige is dwindling. But that is why it is not for everyone.

 

[Richspiders07]

As a 3rd year entering my 4th year, I am well aware that I am not ready to be a resident. I just don't know enough. To put me in charge of patient care on July 1 would be detrimental to the patient and incredibly stressful for me.

Well, as a fourth year about to graduate, I can say I knew a helluva lot more a year ago than I do now not having had a "serious rotation" since Thanksgiving. Most of my classmates feel the same way...

 

[xaelia]

So, my in-service exam score as an intern was above the ABEM threshold for minimum pass. Was I qualified to practice as an Emergency Physician? Theoretically...yes (and, honestly, at least better off than the FP and IM docs where I moonlight). Practically? Hell no.

I do find it mildly amusing that the legal environment requires zero-miss practice, yet 75% on core EM topics is good enough to pass....

 

[Zanegray]

You aren't going to get much pity when your new hours are the same or less than what many of us work.

Agree. We are 3 year but we work 22-10's as a PGY1, 21 as a PGY2 and 19 as a PGY3.

I know ours is only a 3 year program, so grain of salt, but EM hours are most important anyway right?

 

[SepulvedaMD]

Well, as a fourth year about to graduate, I can say I knew a helluva lot more a year ago than I do now not having had a "serious rotation" since Thanksgiving. Most of my classmates feel the same way...

I hear the same things from this year's class, and from the interns in July. But, my observations show that despite this feeling most 4th years additional time on the wards is what makes the difference. Sure there is some clinical atrophy, but those sub-I's prep you well early in the year.

Also, with the exception of time for interviews, the 4th year schedule is largely dependent on student preference. If one wanted a to end the year with Cards, SICU, and trauma then that would be their choice. No many do, but that's another story.

 

[Venko]

Well, as a fourth year about to graduate, I can say I knew a helluva lot more a year ago than I do now not having had a "serious rotation" since Thanksgiving. Most of my classmates feel the same way...

Maybe the solution is to schedule more "serious rotations"...

 

[dchristismi]

I thought 4th year was the reward for surviving 3rd??

 

[jbar]

Also, with the exception of time for interviews, the 4th year schedule is largely dependent on student preference. If one wanted a to end the year with Cards, SICU, and trauma then that would be their choice. No many do, but that's another story.

For those 1-3 year students it's worth remembering that you might be moving across the country, so you have to leave time open in April/May to pack and move. Also a lot of programs start mid June, so often the vacation you take before graduation might be the only real vacation you get.

I was struggling with all this, felt like I hadn't seen a patient in a long time. But I decided that the next step was to be in the ICU or ED as an intern, that I really didn't want to do another rotation where I would just be shadowing (ICU).

One of my classmates who is going into IM is doing a medicine sub-I this month, 2 weeks before starting his IM residency. It works for him but I think at a certain point you have to just say that you are as prepared as you are going to be and no matter what you do intern year is going to be a shock, with a steep learning curve.

 

[13770]

Interesting thread. I"ll return to the original poster.

This is a smoke screen. Your hospital admin is making cutbacks (or your dept needs to increase coverage to offset the increasing volumes) and your department has to save money. The Dept needs to cut the budget. Hmmmmm, do we cut salaries and benefits or do we do something else?

Something else: the residents shall work longer, or more, shifts to offset the volume increases in the ED. Extra coverage at not cost.

The 4 year vs 3 year is always a fun discussion. I"ve never met a 3rd year EM resident in an EM program who wanted to stay another year. And 95% don't need another year. The 5% who need another would not improve with another ten years, IMO.

Three vs Four: make your choice, pay the piper. There are great programs that are 3, there are great programs that are 4. 85% or more in EM are 3.

Oh, and btw, you have no recourse toward offsetting the hours that you're now going to work. There are no contractural elements that say you cannot work more or that you signed on for a certain number. As long as you are in compliance with ACGME requirements that is.

As to the integrity of increasing your hours, well that's a whole different discussion.

 

[CestaVie]

I never said to cut back on basic medical knowledge (1st and 2nd yr), I'm talking about cutting back on BS rotations. It is true that most medical students know a heck lot more end of 3rd year than end of 4th yr because let's face it, who really wants to do hard rotation after thanksgiving. As for the person who said he/she would feel stress out if forced to see patients after 3rd yr... trust me, you aren't going to feel better after 10 years of medical school.... and that's the main point about residency. You lasted this long, you will do fine. You will get thrown into the ocean known as intern year and you will float because you have to. Another 10 years doing BS rotations isn't going to help you any. I would agree that as you rotate through rotations, you will learn to hate/love what you decide, but that can be done early on in your early medical career as well. I believe that having a 4th year is the same reason why college is 4 yrs long... just to hang and chill out and I'm perfectly ok with that.

 

[akomark]

I never said to cut back on basic medical knowledge (1st and 2nd yr), I'm talking about cutting back on BS rotations. It is true that most medical students know a heck lot more end of 3rd year than end of 4th yr because let's face it, who really wants to do hard rotation after thanksgiving. As for the person who said he/she would feel stress out if forced to see patients after 3rd yr... trust me, you aren't going to feel better after 10 years of medical school.... and that's the main point about residency. You lasted this long, you will do fine. You will get thrown into the ocean known as intern year and you will float because you have to. Another 10 years doing BS rotations isn't going to help you any. I would agree that as you rotate through rotations, you will learn to hate/love what you decide, but that can be done early on in your early medical career as well. I believe that having a 4th year is the same reason why college is 4 yrs long... just to hang and chill out and I'm perfectly ok with that.

This attitude/expectation that medical students are "better" or "know more" at the end of their 3rd yr than they do one year later is absurd. The learning and self-improvement should never end in our profession, and if you all think it is normal or ok to not continue to get better while you are still in medical school than Lord knows how you will feel 15-20 years into your career.

This attitude is embarassing. It's like once your application is submitted to ERAS then you're done with medical school. It's immature and a disservice to your future patients to act like this.

 

[EM_Rebuilder]

At U of Mississippi, we work all 12 hour shifts. PGY1 and 2 work 18-19, PGY3 work 15-16, and PGY4s work 12.

The 3 versus 4 year debate has been said many times on here. I guess it comes down to a personal choice. I liked that my program allowed moonlighting and the pay is such in MS that as fourth years we make as much or more than some attendings make. I think I got the benefit of an extra year of education without much hard costs. People can debate if you learn 'much' the fourth year, but regardless, I think its common sense that you will learn at least something. If a program does not allow moonlighting as a four year program, I would not go..

 

[CestaVie]

This attitude/expectation that medical students are "better" or "know more" at the end of their 3rd yr than they do one year later is absurd. The learning and self-improvement should never end in our profession, and if you all think it is normal or ok to not continue to get better while you are still in medical school than Lord knows how you will feel 15-20 years into your career.

This attitude is embarassing. It's like once your application is submitted to ERAS then you're done with medical school. It's immature and a disservice to your future patients to act like this.

Wow, I applaud you sir (or ma'am). I'm glad there are people like you who volunteer to take ICU for 12 months your 4th year. I applaud people like you who donate all your earthly time to research and memorize all the available knowledge in the world in order to better serve your patient. My audacity... to suggest that people of medicine are even remotely in favor of free time and who are against BS scud work. My sincere apologies for suggesting that 2nd year medical students (after taking step 1) know more about basic science than a new intern. It is really true. The world of science revolves around people like you, you are always pushing the boundary of knowledge. I am a disgrace to my profession... how dare I suggest that alot of things in medicine curriculum is a waste... how dare I suggest that writing up a progress note on a nursing home pt that my attending doesn't even read or comment on is a total waste of time... how dare I to even question pulling back fat in a surgical case for 6 hrs is also a total waste of my time.

Medicine needs a world of more people like you my friend... a person who is always trying to better his/herself... and less people like me, a person who will be a "disservice" to my future patients.

 

[deleted109597]

All I'm going to say is this.

The more you learn, the more you realize you don't really know anything.

 

[SepulvedaMD]

All I'm going to say is this.

The more you learn, the more you realize you don't really know anything.

Exactly. Which is why I feel that even though many 4th year electives are "easier" than the core clerkships for 3rd years, they are still honing your clinical gestalt. You are always building.

In medicine, your skills are based on what you read and see. The more you do of either, the better you will be.

 

[AmoryBlaine]

Exactly. Which is why I feel that even though many 4th year electives are "easier" than the core clerkships for 3rd years, they are still honing your clinical gestalt. You are always building.

In medicine, your skills are based on what you read and see. The more you do of either, the better you will be.

True. I still meet people who act as though being a good doctor or resident is the result of some mythical genetic gift.

Look into the lives of the 20 best docs you know, 1 has a photographic memory and is a statistical outlier - the other 19 read a lot and look up stuff they don't know.

 

[Venko]

Wow, I applaud you sir (or ma'am). I'm glad there are people like you who volunteer to take ICU for 12 months your 4th year. I applaud people like you who donate all your earthly time to research and memorize all the available knowledge in the world in order to better serve your patient. My audacity... to suggest that people of medicine are even remotely in favor of free time and who are against BS scud work. My sincere apologies for suggesting that 2nd year medical students (after taking step 1) know more about basic science than a new intern. It is really true. The world of science revolves around people like you, you are always pushing the boundary of knowledge. I am a disgrace to my profession... how dare I suggest that alot of things in medicine curriculum is a waste... how dare I suggest that writing up a progress note on a nursing home pt that my attending doesn't even read or comment on is a total waste of time... how dare I to even question pulling back fat in a surgical case for 6 hrs is also a total waste of my time.

Medicine needs a world of more people like you my friend... a person who is always trying to better his/herself... and less people like me, a person who will be a "disservice" to my future patients.

For what its worth, I loved the two ICUs and cards that I scheduled in the last three rotations of my medical school career (by the way, at the time I was going into psychiatry and these were far from a requirement). The entire rotation was about learning and teaching and not trying to impress anyone. The staff truly knew I volunteered for these to learn and went out of their way to support me and teach me. It was a great experience. Every procedure was mine. Every opportunity was mine.

It is my personal opinion that it is better to continue to push through to the end of medical school....just as it is to push through to the end of residency....etc. This is just my opinion though.

 

[Dwindlin]

It is my personal opinion that it is better to continue to push through to the end of medical school....just as it is to push through to the end of residency....etc. This is just my opinion though.

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