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- Oct 24, 2001
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I am a MS4 who is in the process of applying for residency and I wanted to know if others have noticed a similar phenomenon. Many of the clinical departments at our medical school of undertaking significant overhaul in order to comply with the upcoming RRC residency work hour requirements. Almost without exception, the residents that I talk with are not only in favor of the changes, but looking forward to having limits on the amount of work hours they must put in. However, the faculty for the most part are completely opposed to any change. My favorite arguements from the faculty are :
1) "Back in my day, we used to do Q3 call and there was none of this leaving after noon conference $#&%!"
- Nevermind that "back in my day" was a scant two years ago. I am always tempted to ask whether they had to walk to the hospital in the snow uphill both ways.
2) "Well if they can only work 80 hours a week, then the residency needs to be made a year longer."
- The arguement is often that the resident don't see enough pathology in 80 hours a week to be competent clinicians. However, one could argue that residents at a tertiary care facility (which is what we are) see significantly more zebras in 3-4 years than those at smaller community programs. Is this statement in fact then knocking community programs and smaller residencies?
3) "If the residents are only going to work 80 hours a week and the hospital has to hire extra PA's and NP's to cover the rest of the work, then the residents need to be paying the hospital for their training."
- This particular one irks me in so many ways. How many of us have seen the residents deliver the baby by C-section at 2am while the attending could not be roused from bed, only to know that he will cosign the operative note and still bill for the delivery?
4) "Some of my interns and residents have been very slow, and that's why we don't finish morning rounds until 4pm. You can't expect me to let them go before rounds are finished."
- Interns are slow the first month or so, after that everyone has reached a running pace. At the hospitals where I have rotated the interns have to deal with such a significant amount of scutwork that it can take up to 4 hours of their day everyday. This isn't putting in IV's - it's calling three departments to get the approval to order a swallow study, or waiting on hold for 20 minutes with the only home health care provider that the insurance will pay for. Certainly the interns need to know the logistics of getting these things arranged, but that requires doing it ONCE, not once a week. I would propose that 60% or more of the scutwork can be done by someone without an MD degree (and it shouldn't always be the medical students .
- My other objection to this point is, "Dr. Attending, rounds wouldn't take so long if you weren't answering pages from your spouse and children Qhour." (Sorry, personal pet peeve)
The reason that I am venting is that today I experienced a significant amount of hostility from an entire department of pediatric specialists over this issue. They have already decided that the group of incoming interns are "spoiled brats who are just too lazy to learn how to be doctors." This is certainly not the fellowship of medicine I was hoping to be joining. I would love to hear that others out there are having more positive experiences.
Thanks for letting me vent!
MBK2003
1) "Back in my day, we used to do Q3 call and there was none of this leaving after noon conference $#&%!"
- Nevermind that "back in my day" was a scant two years ago. I am always tempted to ask whether they had to walk to the hospital in the snow uphill both ways.
2) "Well if they can only work 80 hours a week, then the residency needs to be made a year longer."
- The arguement is often that the resident don't see enough pathology in 80 hours a week to be competent clinicians. However, one could argue that residents at a tertiary care facility (which is what we are) see significantly more zebras in 3-4 years than those at smaller community programs. Is this statement in fact then knocking community programs and smaller residencies?
3) "If the residents are only going to work 80 hours a week and the hospital has to hire extra PA's and NP's to cover the rest of the work, then the residents need to be paying the hospital for their training."
- This particular one irks me in so many ways. How many of us have seen the residents deliver the baby by C-section at 2am while the attending could not be roused from bed, only to know that he will cosign the operative note and still bill for the delivery?
4) "Some of my interns and residents have been very slow, and that's why we don't finish morning rounds until 4pm. You can't expect me to let them go before rounds are finished."
- Interns are slow the first month or so, after that everyone has reached a running pace. At the hospitals where I have rotated the interns have to deal with such a significant amount of scutwork that it can take up to 4 hours of their day everyday. This isn't putting in IV's - it's calling three departments to get the approval to order a swallow study, or waiting on hold for 20 minutes with the only home health care provider that the insurance will pay for. Certainly the interns need to know the logistics of getting these things arranged, but that requires doing it ONCE, not once a week. I would propose that 60% or more of the scutwork can be done by someone without an MD degree (and it shouldn't always be the medical students .
- My other objection to this point is, "Dr. Attending, rounds wouldn't take so long if you weren't answering pages from your spouse and children Qhour." (Sorry, personal pet peeve)
The reason that I am venting is that today I experienced a significant amount of hostility from an entire department of pediatric specialists over this issue. They have already decided that the group of incoming interns are "spoiled brats who are just too lazy to learn how to be doctors." This is certainly not the fellowship of medicine I was hoping to be joining. I would love to hear that others out there are having more positive experiences.
Thanks for letting me vent!
MBK2003