I take a day off from SDN, and look what happens. So many things to discuss. Hard to know where to start:
So one of the curriculum deans came to talk to the residents and students on my current rotation today and mentioned that dropping the current 80 hour work week limit for residents to 60 hours/week is currently being discussed (by whoever makes those rules). This isn't the first time I've heard this rumor. Does anyone know more about this and how likely this is?
I think the 80 hour work week was a good idea but 60 hours seems a bit too low...I don't know how they'd do it without extending residencies or increasing the number of residents.
The RRC-IM released, in draft form, the new requirements for IM residencies. It's freely available on the ACGME website if you are interested, its a great cure for insomnia (choose "review and comment" from the main page
www.acgme.org, and follow the links from there). The RRC-IM is usually on the cutting edge of duty hour rules (with a tip-o-the-hat to EM, more on that below). There is nothing about a decrease in the 80 hour workweek. I expect this will be decreased in the future, but not the near future.
There has to be someone complaining for this change to occur. My guess? some residents prob want less hr work weeks.
You know what would fix the problem?
How about we increase the pay for residents? I doubt they would complain if they had a higher salary for their hard work.
From what I have read and heard I think 80 hr work weeks in some specialities are absolutely necessary.
Increase pay and everyones happy! everyone that matters at least haa.
Most of the driver is the patient safety movement, not residents complaining. Whether decreasing hours increases patient safety is unclear (as other posts in this thread document). I am all for increasing resident salaries -- it's just hard to do so as medicine gets squeezed financially from all directions.
When an MBBS graduate obtains ECMFG certification and US state medical license. They are allowed to use the title "MD" after their name.
This is not so clear. Some states (NY notably) used to have a process where someone with an MBBS could submit their degree with a fee and get an "MD" in return. That process has been stopped, I believe. At the current time in most states, your degree is what it is -- you should be proud of your MBBS, DO, or MD. Simply putting MD after your name might be considered fraud, and should be avoided unless you have clear documentation that it is acceptable.
What they probably should do is obey the letter and spirit of anti-trust legislation and renounce their congressional exemption contained in an omnibus spending bill (I'm talking about the match) and allow us to compete for residency spots AND wages just like any other worker. Hospitals make about $100k for every resident, yet their pay is less than half that because they're the ones running the monopoly.
This is very complicated. Are you sure you want to let market forces control this? I get one email each week from an IMG offering to do a residency for free. Various specialties in IM used to not have a match, and their salaries were no better without the match. Programs currently advertise their salaries before the match, and you are free to rank them based on salary if you wish. If residents do so, programs will increase salary to be more competitive, even with a match. I;m not convinced it's the match that's the problem.
As for resident funding, yes programs get about $100K for each resident. However, when you add all the direct costs for residents -- salary, benefits, salary support for PD's and PA's, match costs, accreditation costs, GME office costs, space for the residency program, etc, it ends up being not a huge money maker.
Before Faebinder complains, however, this ignores the indirect cost savings that residents provide -- i.e. the cost of hiring someone else to do the work that you are doing. That's where most of the "money making" is.
Perhaps the ACGME could consider an OPTIONAL 60 hour week with time added to the residency, for those who wish to go on the mommy/daddy track. But honestly, people, you volunteered for this, it's only a couple of years (nonsurgical senior residents already work closer to 60 hours than 80), and you had 4+ years of warning to organize your family life.
Or, how about more $$$ or an extra week of vacation?
This would be a nightmare to organize as a PD. Creating a ward rotation that's 80 hours for one person and 60 hours for another is a mess. Some programs already offered shared spots -- two people share one spot, work half time for twice the length. I don't think they're very popular, but I may be wrong.
As I mentioned above, I'm all for more salary for residents, but I don't know where it's coming from. Our medical system (and the entire government, for that matter) is going bankrupt. We continue to borrow more and more money, counting on the economy to grow further (so that the percentage of debt remains stable). That works great while the economy is growing. When it shrinks, it's a disaster. That's exactly what happened to the housing market in the US.
Disclaimer: As an Emergency Medicine Resident I probably work less than 60 hours per week, usually around 50...but I did do two traditional intern years.
I'd rather do an extra year of residency with decent hours.
ED has a distinct advantage in this regard to IM or GS -- there is no "patient continuity". You can work a shift, sign out, and when you come to your next shift all the patients have changed. Once you expect some patient continuity, building a schedule that max'es at 60 hours is very difficult.
Then again, ED training is 4 years, compared to IM's 3.
How will that help? Won't they just take spots previously occupied by IMGs, resulting in no change in the number of board certified physicians entering practice in the US each year?
Yes, they will. As US medical schools increase enrollment (which they will do as they are hurting for $$ also, and more students is more $$), they will take people further down on their admission lists. This will "steal" people from the DO and Carib IMG schools, so those schools will also admit people lower on their lists. The US cannot afford to open more residency slots, as Medicare is already going bankrupt, so the net result will be more US grads and less DO/IMG's in allopathic residency slots.
There is nothing wrong with having a 60 hour work week for residency. The vast majority of the resident's time is spent doing non-educational activity. The scut will simply have to be cut out. The hospitals will have to hire someone else to fill out the jaco forms (irrelevent anyway), draw labs (phlebotomist should be doing this), transport patients (hire transporters), etc etc etc.
Very little of the day is spent "learning."
-The Trifling Jester
This is where things get really tricky. The scut listed above is completely unacceptable. In IM, it is completely forbidden by our accreditation rules. However, there is lots of "pseudo-scut" -- things that have some but little value. Discharge summaries are a good example -- you clearly need to know how to do them, but how many do you have to do to get good at them? Calling radiology to get a CT for your patient -- you could have a secretary do this, but what happens when the schedular on the other side says "We can do it in 6 hours", is that good enough? If you call yourself, you can triage how important it is. How to offload this from residents is unclear -- each resident could get a "personal assistant", but again it's unclear if this would really help.
Seriously, I would so extend my residency by one year if I had a 60 hr work week! That means living life like a somewhat normal person and not being tired and exhausted all the time, sign me up! Actually , there has been some recent small studies that have shown there are no loss of procedures due to the works hours but in some case increased the number of procedures b/c night float! Go figure but I would choose to do an extra year for a bit more normal life!
And many others would disagree and complain that they wanted to finish in one year less. I guess some programs could offer a 60/4 program, and others an 80/3, and let the match / market forces sort it out. Congress would need to authorize the additional funds for the 4th year, or programs would need to absorb the added cost.
If hours are cut, they won't cut the scut. The current system creates a monopoly, and someone is going to write the discharge summaries.
New lawyers working at the big firms often work 80+ hours a week, but they are ofte paid very well to essentially train. Anyone can put up a shingle and become the equivalent of a legal GP and no one will question them, fail to provide a court license (j/k), or limit their income. They can learn on the job. There are also lower pay jobs with fewer hours.
Med school should be three years. The fourth year should be the equivalent of a TY internship with real responsibility. Residency should then be optional after that. If they weren't a licensing requirement, they'd have to pay real moey to fill.
Scut - see notes above.
Lawyers are not a completely fair comparison. A few lawyers get to work at the big firms and make big bucks. Many don't. Law firms are not bound by the same financial issues as hospitals -- they can bill what they want, and their clients pay. Rarely do people have legal emergencies at 2AM.
Three years of med school is not completely unreasonable. I assume you are suggesting combining 1st and 2nd year into a single year. if you're suggesting leaving years 1-3 alone and simply dropping the 4th year, it leaves the problem of when you would look for a residency program. In the middle of your 3rd year, before you've completed all of your core clerkships?
ask the neurosurgery residents when you hit the wards 
