Resident work hour restrictions

[keithslc]

Has anyone heard anything new about where things are with the new IOM work Hour rstrictions. When Is the ACGME going to implement these? are they going to?


thanks in advance.

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[Krazykritter]

Here's to hoping for never...


Those restrictions were ridiculous & too restrictive for any of the surgical specialties & probably many others as well. How are you supposed to learn to operate if you can't be there to operate??

 

[FatKid]

Here's to hoping for never...


Those restrictions were ridiculous & too restrictive for any of the surgical specialties & probably many others as well. How are you supposed to learn to operate if you can't be there to operate??

They do just fine in Europe.

Resident work hours need to be reduced to no more than 60-hours per week. Hospitals need to stop using residents as cheap slave-labor and pay us what we're worth.

Residents should be making $100k per year.

 

[Miami_med]

Particularly as applied to night-float and napping, the new restrictions were borderline ******ed. Also, the inability for one resident to alternate Fri-Sun calls with another in order to generate a free weekend periodically will be a morale killer in small programs. There were a LOT of problems with the recommendations. Whether residents should be better paid or not is really a different question when compared to a top down mandate.

 

[Winged Scapula]

They do just fine in Europe.

Resident work hours need to be reduced to no more than 60-hours per week. Hospitals need to stop using residents as cheap slave-labor and pay us what we're worth.

Residents should be making $100k per year.

Are you willing to be a PGY-11 just finishing surgical specialty training because of those reduced hours?

...I thought not.

Who is going to pay the $100K - the government? Since CMS doesn't pay much more than that, that means YOU will now be responsible for your health insurance, malpractice insurance, no hospital food or book fund, no CME etc. These benes add up to about $50K per year depending on location. Still interested?

...I thought not.

Don't get me wrong, I think residents deserve every penny, but until you come up with a solution to pay programs more, residents aren't going to get more.

 

[FatKid]

Are you willing to be a PGY-11 just finishing surgical specialty training because of those reduced hours?

...I thought not.

Who is going to pay the $100K - the government? Since CMS doesn't pay much more than that, that means YOU will now be responsible for your health insurance, malpractice insurance, no hospital food or book fund, no CME etc. These benes add up to about $50K per year depending on location. Still interested?

...I thought not.

Don't get me wrong, I think residents deserve every penny, but until you come up with a solution to pay programs more, residents aren't going to get more.

Nope. Residency lengths should stay the same number of years and should be 60 hours a week just like in Europe.

Hospitals and PD's use the guise of "patient safety" to justify inhumane working conditions of residents.

You and I both know what the real reason is: $$$

 

[Winged Scapula]

Nope. Residency lengths should stay the same number of years and should be 60 hours a week just like in Europe.

But residency lengths AREN'T the same here as in Europe; that was my point. You reduce the work hours, you lengthen the residency. I don't know of any resident or attending that thinks shortening the time spent in educational pursuits is a good idea. There just isn't enough time to learn all that stuff.

Hospitals and PD's use the guise of "patient safety" to justify inhumane working conditions of residents.

You and I both know what the real reason is: $$$

While I don't disagree that there is a lot of abuse its hardly "inhumane".

 

[Samoa]

I just don't see the need. 80 hours/week is hard, but certainly not inhumane or impossible. And I don't see how it can be reduced further without compromising resident education, and ALSO patient care with too many handoffs.

Whether a program is humane or not depends on the character of its program leadership, not whatever rules the ACGME writes on paper (and which are generally worth no more than the paper in question). Work hour restrictions aim at the wrong target, if the goal is to make residency more humane and patient care more error-free.

 

[Elfy]

Are you willing to be a PGY-11 just finishing surgical specialty training because of those reduced hours?

...I thought not.

Who is going to pay the $100K - the government? Since CMS doesn't pay much more than that, that means YOU will now be responsible for your health insurance, malpractice insurance, no hospital food or book fund, no CME etc. These benes add up to about $50K per year depending on location. Still interested?

...I thought not.

Don't get me wrong, I think residents deserve every penny, but until you come up with a solution to pay programs more, residents aren't going to get more.

Winged Scapula, I'm interested in where you get your data. While I have no claim on having exhausted the database below or every single other database out there, I couldn't find info so far on surgical residencies (or any residencies) being 11 years long in Europe, most likely up to 5-6 years long @ 40-60 hours a week. And don't get me wrong either, I ask as an European.

http://www.helmsic.gr/residency-database/countries

 

[Winged Scapula]

Winged Scapula, I'm interested in where you get your data. While I have no claim on having exhausted the database below or every single other database out there, I couldn't find info so far on surgical residencies (or any residencies) being 11 years long in Europe, most likely up to 5-6 years long @ 40-60 hours a week. And don't get me wrong either, I ask as an European.

http://www.helmsic.gr/residency-database/countries

I never said surgical residencies are 11 years in length, but I have known surgical residents who are PGY-11. As the competitiveness waxes and wanes, you may spend a few years as an RMO or non-surgical registrar before getting into specialty training.

While a surgical residency may be 6 years long in most European countries this comes after the Intern and RMO years, so a minimum of 8 years, provided you get into training starting your PGY-3 year as a SHO.

In addition, talk to many surgical consultants in the UK and other European countries and those that have done some training in the US often say that they do not feel as well trained as their US counterparts because of the reduced hours. In addition, you should be aware that many of those training outside the US complain about the same things we do here: working over hours. While they may not work 80 hrs per week regularly, most I've spoken to laugh at the "restrictions" and say they are always in the hospital working after hours.

However, I will allow for the fact that I have not kept up with any recent changes, but surgical training is not started right out of medical school in most of the rest of the world like it is in the US.

 

[colbgw02]

These work hour restrictions remind me so much of speed limits. They make the speed limit 35 mph because they know people will drive 55 mph anyway. The problem is that some people actually do drive 35 mph, in the left lane no less, and get in everybody else's way. Just enforce the 55 mph limit and be done with it.

 

[FatKid]

Residency work-load hours should be capped at 60 hours per week.

If someone wants to work extra hours because they CHOOSE TO, then that is perfectly fine, but the training should be designed so that 60-hours for 5+ years is adequate.

Everybody on this board knows, that medical education is one of the most inefficient, archaic and out-of-date systems there is.

 

[NotAProgDirector]

training should be designed so that 60-hours for 5+ years is adequate.

I expect you may be in the minority who would be willing to swap a 3 year / 80 hour residency for a 5 year / 60 hour one.

However, it can be argued that ED is a 3 year / 60 hour field, and if they can do it that way why can't IM? Surgery is a different beast, since there it is all about surgical experience.

 

[Winged Scapula]

I expect you may be in the minority who would be willing to swap a 3 year / 80 hour residency for a 5 year / 60 hour one.

If I read FatKid's posts correctly, he is NOT willing to swap.

He wants to reduce hours without changing the length of current residency training.

 

[Acherona]

well, what about hiring more people to do the scutwork so residents can focus on learning how to doctor. I'm sure most residents spend at least 20hrs/week on scut. For example, residents shouldn't be wasting their time making appointments for patients and never-ending social/dispo issues. Of course they won't do this, exploitation is so much easier.

 

[DrFraud]

While I am not a big fan of doing 80+ hour weeks, if you are around two groups of docs, one that has 3 or more years of a U.S residency, and another with a similar training from a less demanding program in Europe, it is very clear that the U.S training in comparison to those from other programs in other contries with less demanding schedules is superior.

I'm not criticizing the doc's from abroad in any way, shape, or form. Rather, i'm comparing residents.

It's a combination of factors that makes a difference, including the hours, the lectures, the board exams, the responsibilities and expectations, etc. I think it would be a big mistake for the U.S. to model their programs after programs that have lower expectations for their medical graduates.

 

[FatKid]

well, what about hiring more people to do the scutwork so residents can focus on learning how to doctor. I'm sure most residents spend at least 20hrs/week on scut. For example, residents shouldn't be wasting their time making appointments for patients and never-ending social/dispo issues. Of course they won't do this, exploitation is so much easier.

^ This.

 

[FatKid]

If I read FatKid's posts correctly, he is NOT willing to swap.

He wants to reduce hours without changing the length of current residency training.

What I am saying, is that if we had an efficient training system in the U.S. where residents aren't abused and forced to do meaningless scutwork, with 60-hours per week of ACTUAL HANDS-ON TEACHING/LEARNING, this would easily prepare us for independent practice.

The reason why people say 80+ hours is required, is because residents are being exploited to do the scutwork that technicians/secretaries/mid-levels should be doing, AND ARE DOING in the real world.

Again, it's all about $$$. Any PD that tells you otherwise is full of ****.

 

[Winged Scapula]

What I am saying, is that if we had an efficient training system in the U.S. where residents aren't abused and forced to do meaningless scutwork, with 60-hours per week of ACTUAL HANDS-ON TEACHING/LEARNING, this would easily prepare us for independent practice.

The reason why people say 80+ hours is required, is because residents are being exploited to do the scutwork that technicians/secretaries/mid-levels should be doing, AND ARE DOING in the real world.

You seem to have had a very bad medical school experience to be so embittered. I agree with you that a lot of medical education is not very educational. I disagree that residents are abused and treated inhumanely, at least not in most programs.

But let me enlighten you as to what really goes on in a private medical practice since you are NOT in the REAL WORLD as a medical student (probably at an academic medical center):

I do the admissions and discharges.

I do the billing.

I do the dressing changes and wound checks.

I do all the procedure, admission and discharge dictations.

I remove all the drains, sutures, staples.

I dictate all the notes and then proofread them.

I call the consults.

If a patient needs a stat test, I am calling the lab, department, etc. to get it done (as I did yesterday for a patient in the pre-op area with angina; no one called Nuc Med to schedule the Persantine Stress test for me or called the cards consult. I did it.) or am doing it (the test) myself.

I am talking to the families in the waiting room.

Large practices can employ mid-levels to do some of the above, but the vast majority of medical and surgical practices do no and thus, the attendings are doing all of this, without residents, midlevels, ward secretaries, etc.

Don't get me wrong...I have a great office staff and the hospital allied staff are very kind and helpful, but all of the above are considered my job. Do not assume that because you see PAs doing discharge summaries that residents don't need to know how to do them.

While you may see midlevels/techs/secretaries doing what you consider "scutwork", residents do need to do learn to do some of this because they cannot expect that they won't need those skills in practice. There is probably too much time wasted during residency doing these things, but IN THE REAL WORLD, attending physicians are doing this.

The ignorance is not your fault - its pretty characteristic of all of us who trained at academic medical centers, but please know that the vast majority of care in the US is not at these places and that most physicians don't have residents/mid-levels/secretaries and techs to do these things for them.

I am <honestly> interested in why you think that 60 hours per week is sufficient time to learn everything you need to know during residency, without lengthening residency. As noted above but another user, it is true that physicians coming out of training outside the US are much less prepared for practice and those that I've spoken to will readily admit that the expectations for new physicians is lower and that they take a few years post-residency to get up to speed. You can't have that in the US medical environment. In addition, are you postulating that ALL specialties could learn their craft in 60 hours? I would find it difficult to train surgical residents in that amount of time given the breadth of information and technical skills that need to be gained.

 

[Winged Scapula]

well, what about hiring more people to do the scutwork so residents can focus on learning how to doctor. I'm sure most residents spend at least 20hrs/week on scut. For example, residents shouldn't be wasting their time making appointments for patients and never-ending social/dispo issues. Of course they won't do this, exploitation is so much easier.

Where is the money coming from?

Many academic medical centers already operate in the red, without having to spend hundreds of thousands of dollars each year to hire mid-levels.

 

[Law2Doc]

Where is the money coming from?

Many academic medical centers already operate in the red, without having to spend hundreds of thousands of dollars each year to hire mid-levels.

Yeah, Fatkid is sort of right that it's all about the money, but not in the way he means it. Hospitals are willing to engage in teaching residents because residencies are a cash cow for the hospitals. But they aren't getting enough money per resident that it's worth it, as he seems to assume. It's only the money plus the labor makes it a good deal for them. Without the labor component no hospital would set up a residency -- it's not affordable when you factor in the insurance cost, administration, etc involved in shepherding a bunch of new MDs until they can operate nearly autonomously without killing people. It's not like residencies are funded with enough that the hospital can say sure, come in for 60 hours and we will teach you -- enjoy. Instead they get a pittance, and supplement it by the fact that this is very cheap labor. Many places would probably forego the residency funding and simply accept the labor, but not many places would do the other way round.

 

[Excelsius]

well, what about hiring more people to do the scutwork so residents can focus on learning how to doctor. I'm sure most residents spend at least 20hrs/week on scut. For example, residents shouldn't be wasting their time making appointments for patients and never-ending social/dispo issues. Of course they won't do this, exploitation is so much easier.

Maybe that's why you try to get into a top residency program so that you are not forced to spend so much time on scut. After all, not everyone is complaining about scutwork, so there must be a huge variation between different programs. It should also vary across the specialties. If you don't want to deal with patients that much, then you should go into an appropriate field. You can't expect much isolation if you're in a field like psychiatry or PC. Many of us here choose a specific specialty because of this very same issue. You don't want to view your career as one long scutwork.

 

[SocialistMD]

What I am saying, is that if we had an efficient training system in the U.S. where residents aren't abused and forced to do meaningless scutwork, with 60-hours per week of ACTUAL HANDS-ON TEACHING/LEARNING, this would easily prepare us for independent practice.

Please, for the love of god and all that is holy, just stop. You have no experience or authority from which you draw your conclusions. A surgical chief resident at my program arrives at 6am to blaze through rounds in time to be in the or for the first case at 7:30. S/he will be in the OR (minus downtime between cases or the half-day clinics once or twice a week) constantly until 4:30 or later. S/he then rounds on the patients at the end of the day to make sure everything that was supposed to happen did and to make sure everyone is still okay. If everything goes smoothly, that is done at 6pm. This goes on 5 days a week and there is no scut. 12hrs/day * 5 days = 60 hours. Our chiefs don't have to take in house call and don't have to see consults (the R-3s manage the consult service). We have mid-levels that go to clinic with us and take care of scheduling pre-operative studies/consults that we want so we aren't "wasting our time" scheduling things like that. Our chiefs do have to round on the weekends (3-4 hours/day every other weekend) and they do have to come in at night if a patient goes south and needs to go to the unit/back to the OR. In short, the minimum a chief resident can work in a given week is 60 hours. That never happens. Every other year has a night float system and is at or near 80 hours each and every week on nearly every service because they have to be in-house (on average) one night a week.

 

[FatKid]

Yeah, Fatkid is sort of right that it's all about the money, but not in the way he means it. Hospitals are willing to engage in teaching residents because residencies are a cash cow for the hospitals. But they aren't getting enough money per resident that it's worth it, as he seems to assume. It's only the money plus the labor makes it a good deal for them. Without the labor component no hospital would set up a residency -- it's not affordable when you factor in the insurance cost, administration, etc involved in shepherding a bunch of new MDs until they can operate nearly autonomously without killing people. It's not like residencies are funded with enough that the hospital can say sure, come in for 60 hours and we will teach you -- enjoy. Instead they get a pittance, and supplement it by the fact that this is very cheap labor. Many places would probably forego the residency funding and simply accept the labor, but not many places would do the other way round.

^ This.

Hospitals and PD's do not care about teaching. They only care about one thing: $$$

That's how the world works ladies and gentlemen.

 

[Acherona]

Where is the money coming from?

Many academic medical centers already operate in the red, without having to spend hundreds of thousands of dollars each year to hire mid-levels.

Yea well this is because our healthcare system is screwed up and insurance companies gobble up all the money. Some hospital admins also make exhorbitant salaries. Clearly something needs to be done so money is going to the right places. Unfortunately I'm not that impressed with what Obama has to say so far.

If I have to learn how to make an appointment or call a consult for a patient when I go into private practice, I'm pretty sure I"ll be able to pick up those skills, in like, 20 seconds.

 

[Acherona]

Maybe that's why you try to get into a top residency program so that you are not forced to spend so much time on scut.

um, we're talking about problems with residency education as a whole, not how you as an individual can beat the system.

 

[KluverB]

Maybe that's why you try to get into a top residency program so that you are not forced to spend so much time on scut.....

If by "top" you mean places like Mayo, MGH, JHopkins, Cleveland Clinic, WashU, etc. I guarantee that they have far more "scut" than the "not-so-top" places.

 

[Ashers]

I talked to one of my friends in London who is doing anesthesiology/anaesthetics. He will be in residency for 10 years before he's allowed to practice on his own, and according to him, that's standard for over there. He's already finished 5 years, so I'll be done with my 4 years of anesthesia before he's done with his training.

 

[FatKid]

Yea well this is because our healthcare system is screwed up and insurance companies gobble up all the money. Some hospital admins also make exhorbitant salaries. Clearly something needs to be done so money is going to the right places. Unfortunately I'm not that impressed with what Obama has to say so far.

If I have to learn how to make an appointment or call a consult for a patient when I go into private practice, I'm pretty sure I"ll be able to pick up those skills, in like, 20 seconds.

Exactly.

The reason why health care costs are so high is because of insurance companies.

The insurance company is a MIDDLE MAN. Health care should be set up directly between the physician and the patient.

There is NO NEED for health insurance companies other than for emergency situations (heart attack, stroke etc...)

Unfortunately, the insurance company lobby that is padding Obama's pockets will not allow themselves to lose their stranglehold over the U.S. health care system.

 

[SoCuteMD]

I talked to one of my friends in London who is doing anesthesiology/anaesthetics. He will be in residency for 10 years before he's allowed to practice on his own, and according to him, that's standard for over there. He's already finished 5 years, so I'll be done with my 4 years of anesthesia before he's done with his training.

As I understand it, their training salaries are significantly higher than hours, which softens one of the blows of having a longer residency.

 

[Ashers]

As I understand it, their training salaries are significantly higher than hours, which softens one of the blows of having a longer residency.

Interesting, I've never talked to my friends about that. When my friend who's doing a pediatrics residency graduated 2 years ago, she was only paying £2500/year for tuition in London (and she was complaining it wasn't free), so they definitely don't have as much debt to worry about. I'll have to ask about all that stuff when I go back in a few months.

 

[Winged Scapula]

Interesting, I've never talked to my friends about that. When my friend who's doing a pediatrics residency graduated 2 years ago, she was only paying £2500/year for tuition in London (and she was complaining it wasn't free), so they definitely don't have as much debt to worry about. I'll have to ask about all that stuff when I go back in a few months.

That reminds me of the Aussies who were worked up about paying that much for tuition as well...I guess if it had been free the year before, it does seem like a substantial increase.

When I was a student the Aussie residents were making around $50K AUD (the exchange rate was almost 1:1 back then) while Americans were making $35-$40K. So not significantly more, IMHO, but it was a nice benefit for the longer training. They were also paid overtime if they stayed over 50 hrs per week, although it was HIGHLY discouraged to be doing any overtime (ie, the same complaints you get here about not being able to do your job in the time allotted).

 

[Mistress S]

I would be perfectly okay with working a 60 hr/wk residency for 5 yrs (as it is done in many European countries) v. an 80 hr/wk residency for 3. I may be in the minority, but I kind of doubt it- many people are starting or already have families when beginning residency, and a 60 hr week would make this infinitely more manageable. I can't imagine many people with kids or planning to have them in residency preferring an 80 hr work week.

Of course, this would be provided we also had European-style debt and pay; with my current six-figure loans (now all accruing debt throughout my residency, with the removal of the economic hardship deferment option) and <$50k/yr pay, additional time in residency means thousands of extra dollars in interest while I get paid too meager of an income to repay my loans. I don't know about all European countries, but I have spoken to a number of residents from the UK, all of whom had minimal med school debt (<$50k) and got paid the equivalent of $90K/yr from intern year on. That sounds like a sweet deal, and a much better lifestyle. Why should people have to essentially pause their lives to complete residency, or (if they choose to proceed with starting a family, as most people our age are doing by this time if they haven't already) have to essentially miss out on 3 years of their children's and significant other's lives? In a rational world, we would switch to a 60 hr/wk extended residency, with Medicare funding increased to provide a reasonable resident salary (min. $75k/yr) so the extended time would not pose an economic hardship. As it is, I'm not holding my breath.

 

[Winged Scapula]

I would be perfectly okay with working a 60 hr/wk residency for 5 yrs (as it is done in many European countries) v. an 80 hr/wk residency for 3. I may be in the minority, but I kind of doubt it- many people are starting or already have families when beginning residency, and a 60 hr week would make this infinitely more manageable. I can't imagine many people with kids or planning to have them in residency preferring an 80 hr work week.

You actually are. Those studies have already been done, and the majority of IM, FM and Surgical residents would not endorse lengthening training for lower work hours.

I do not believe they separated out the results by marital status, so perhaps it would be true that those with families would prefer the longer training although for the reasons you gave, as well as getting out into the salaried workforce, many would still likely prefer to keep training as short as possible, even if it means longer work hours per week.

 

[Law2Doc]

...

I do not believe they separated out the results by marital status, so perhaps it would be true that those with families would prefer the longer training although for the reasons you gave, as well as getting out into the salaried workforce, many would still likely prefer to keep training as short as possible, even if it means longer work hours per week.

I think it's a safe bet that the majority of folks with families would opt to get into the private sector sooner. Nobody with mouths to feed is going to be excited to extend a low paid residency for a few more hours per week.

 

[Winged Scapula]

I think it's a safe bet that the majority of folks with families would opt to get into the private sector sooner. Nobody with mouths to feed is going to be excited to extend a low paid residency for a few more hours per week.

That was my assumption as well, but Mistress S is arguing the opposite. Although I would hardly call the difference between 60 and 80 hrs per week as a "few", but is it worth an extra year or two?

 

[bluealiendoctor]

There's actually even more to it. For those with kids, having family nearby to help makes an enormous difference when it comes to your time away from the kids. Being able to drop your kid/kids off at mom's/sister's/brother's house and not being worried about time is paramount for a parent's mental state. Financially, it's golden as well. Daycares don't support the time frame often needed during residency so you find yourself having to supplement the out of daycare hours with yet another hired nanny/sitter, etc. The cost quickly becomes enormous especially if you and your spouse are both residents. For people in that situation, an 80 work week starts to border on financial impossibility along with the emotional strain on their children.

 

[Winged Scapula]

The above is very important for ANYONE with an unpredictable job.

My business partner has her kids in a day care/after school care program. You must pick them up by 515 pm or something happens. I don't know what but they apparently charge you by the MINUTE when you are late.

So, she's an attending and the money issue isn't paramount but surgery, like most medical fields can be unpredictable. The problem with daycare during residency is that you CANNOT be absolutely certain you will be able to walk out of the hospital at the time you think you will.

Having family nearby is a big relief my friends tell me, or a spouse with a flexible schedule (my partner's husband has one, so he usually picks up the boys).

 

[Danbo1957]

Again, it's not the amount of hours or the length of the residency that matters (30-40 years-ago one could practice as an IM attending after the intern year), it's how well the resident is trained - we're working on it...

 

[SocialistMD]

If by "top" you mean places like Mayo, MGH, JHopkins, Cleveland Clinic, WashU, etc. I guarantee that they have far more "scut" than the "not-so-top" places.

Not true. We have nurse practitioners on each surgical service (more than one on the busier services) that basically do what the interns did some four-five years ago. There is little to no scut left and we are 80-hour compliant, but just barely. Cutting our hours would not be possible.

 

[Mistress S]

That was my assumption as well, but Mistress S is arguing the opposite. Although I would hardly call the difference between 60 and 80 hrs per week as a "few", but is it worth an extra year or two?

Actually, I wasn't arguing the opposite- if you read my post, I specifically said I would endorse a longer residency as is commonly done in European countries provided I also had a similar debt load and salary as residents in those countries typically enjoy.

I fully agree that, under our current system, spending more time in a low-paying residency with interest mounting on our tremendous debt is not financially feasible for most people, all the more so for those with families to support. If, however, I could work 60 hrs/wk making >$80k/yr and with <$50k of debt to pay back and have to extend my residency by a couple of years in exchange, that would be an excellent and much more family-friendly alternative to our current system in my opinion. Some would no doubt still disagree, but I imagine many residents, particularly those with families, would prefer this as well.

 

[Winged Scapula]

Actually, I wasn't arguing the opposite- if you read my post, I specifically said I would endorse a longer residency as is commonly done in European countries provided I also had a similar debt load and salary as residents in those countries typically enjoy.

I fully agree that, under our current system, spending more time in a low-paying residency with interest mounting on our tremendous debt is not financially feasible for most people, all the more so for those with families to support. If, however, I could work 60 hrs/wk making >$80k/yr and with <$50k of debt to pay back and have to extend my residency by a couple of years in exchange, that would be an excellent and much more family-friendly alternative to our current system in my opinion. Some would no doubt still disagree, but I imagine many residents, particularly those with families, would prefer this as well.

You're right...I had forgotten about your second paragraph in which you said that.

 

[ozzie20]

Winged is right, residencies are longer in the UK/Europe. HOWEVER, what most people aren't looking up is that most students enter medical school straight from high school, entering into a 5 year medical program. This cuts off around 3 years off of your training before you get into residency.

Basically, they shifted the residency times to be longer in exchange for no college education. This simply cannot be done currently.

 

[Winged Scapula]

Winged is right, residencies are longer in the UK/Europe. HOWEVER, what most people aren't looking up is that most students enter medical school straight from high school, entering into a 5 year medical program. This cuts off around 3 years off of your training before you get into residency.

Basically, they shifted the residency times to be longer in exchange for no college education. This simply cannot be done currently.

While true that most medical schools outside of the US are for high school leavers, I don't think that's relevant here.

The concern is working for more years while being paid a relatively lower salary in exchange for shorter hours.

I suppose in the sense that if you started medical school at 18 instead of 22 later, you would be in the work force at around the same time might be important to some, I think the point I was making is that everyone was seemingly enamoured of the British system because of the shorter hours, without realizing that the training scheme, in which the shorter hours are rewarded with less pay than you would make as a consultant, takes longer.

 

[platon20]

While you may see midlevels/techs/secretaries doing what you consider "scutwork", residents do need to do learn to do some of this because they cannot expect that they won't need those skills in practice. There is probably too much time wasted during residency doing these things, but IN THE REAL WORLD, attending physicians are doing this.

Attendings are on the phone scheduling endoscopies, specialist visit referrals, etc personally?

Bull****. Their secretaries do that crap.

 

[Winged Scapula]

<p>Sorry but when my patient needed a stress test and a cardiology appt last week I did it. You are ill informed: private practice physicians do not have secretaries. I suppose I could have called my office mgr to do it but in the time it would have taken me to call her and for her to gather all the information she needed to make those appts and then called me back I could have easily had it done. It is much faster and more efficient to things yourself sometimes.</p>
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<p>I invite you to come join me or any of my friends in the office to see what we do on a day to day basis. Then we can see who's full of ****.</p>