NinerNiner999: "get in the real world" LOL. Face it friend, residency is the real world. Working your butt off for peanuts, scraping by paycheck to paycheck, long hours away from your family, people disrespecting you and loving you. Patients saying they are grateful for your time, others spitting on you. Bills are due, laundry is piled up and the kids are hungry and/or sick. Your brakes are going out on your car but daycare is knocking for your dues. Half days for research are spent fixing that toilet that flooded your bathroom. Oh, and you're up for presentation tomorrow morning.....nothing big, you should be able to put it together in a few hours. Your white coat looks like a sex rag and that five o clock shadow has to go. Not real enough for you?
Yes, very real yet no-not real enough. (BTW - I like the sex-rag coat LOL). Everything you mention above is true about residency - and life in general with any job, but from the perspective and mind-set of a resident. My point is that regardless of the hours you spend in residency learning, or the hours you spend as an attending practicing, you will spend 70-80 hours per week working from a different vantage point.
As a resident, you will be doing the majority of things (SCUT, patient follow-up, call, etc) FOR your attending, while learning in the process. As an attending, you will be doing EVERYTHING for YOUR practice, and putting the patient first at all times. It's funny how different things are when you're on cross-coverage in your 70th hour of the week for your fellow resident team, compared to when you're in the hospital at 10pm on Friday night for the quality committee meeting that your group is required to participate in for hospital privileges, only hoping the meeting gets out by 11 so you can finish rounding on your private practice patients you have admitted.
I agree wholeheartedly that the real world as you describe it exists in residency from your vantage point. I'm only suggesting that residents who graduate from their programs working less than they will as attendings will be in for a rude awakening, and may be underestimating the actual demands of private practice medicine. Further, I express concern that residents who graduate and plan to work less hours - no matter what - may erode further at the autonomy that we as physicians are already losing because they aren't prepared to / don't want to / simply can't tolerate working the hours needed to keep our profession open to private industry.
I do not have any data to back up these concerns, but I do hope that the residents in training now will take any free time in their week above their work-hour restrictions to educate themselves on the economics, political considerations, liability/tort reality, and other "non-clinical" aspects of medicine that are never taught in our medical schools or in our esteemed residencies, and will ultimately be the true sad loss of medical education in our country. I do not have this data because it has NEVER been compiled, and until we focus on the problem of medicine as a whole, from the beginning of our medical education and residency training, it will never be addressed. Look around - nobody in medicine is being threatened because they are giving good care (and I don't feel that shortening the work hours will dramatically impact your ability to learn your specialty). They are being threatened because all they focused on during their training is how to deliver that care - not the mechanics and infrastructure of how we economically deliver it.
To stay on topic, I would hope that residents who are being greeted with reduced work hours will embrace the OPPORTUNITY to learn beyond how to do things, but the multitude of reasons WHY we do things. Data from review of the 80-hour work week reduction has already demonstrated that residents are not studying or applying their free hours to eduction outside of the hospital. To the point, I am begging that the the new generations of graduating residents will focus on how to prevent the slippery slope of government regulation from eliminating our ability as professionals to practice for ourselves, autonomously, and without restriction or oversight FOR our patients. We work as residents with work hour reductions to ultimately work as residents for the government for the rest of our lives. Read that sentence again. The trade-off is our ability to practice with autonomy.
We are at a crossroads in our profession that transcends any work hours, tests, boards, rounds, call nights, or patients we care for. We are truly facing the demise of our ability to treat patients the way we want, and the way we deserve. I hope that each and every resident graduates and finds the job of their dreams and has the ability to help everyone the way that they want to - likely for the same reasons they went into medicine in the first place. Sadly, I fear a day will come when residents will graduate into mandated government servitude with regulations, guidelines, and fiscal oversight dictating their every move. I beg you all - plan on working no less than 80 hours per week in residency, even if 20 hours of it is at home learning about how to fix healthcare in this country. If we can't do it as physicians, then we as physicians will no longer have any direct say into how our patients are treated in the future.
Sorry for the length of this post - I just wish someone had told this to me before I started residency.
