Surgery FAQs

[Blade28]

Originally posted by Masonator
Usually they want a 90 or higher on the two digit score.

OK, good. Phew!

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[Vincristine]

Originally posted by Blade28
Hmmm...yeah, I see that. Well, I'll be at Harvard in October, so hopefully I'll get a recommendation by the end of the month.

Blade, have you somehow bypassed the rediculous HMS visiting clerkship application and already know you'll be there? (If this is just positive thinking, I'm not knocking you, just looking for tips.)

 

[Vincristine]

Originally posted by Masonator
Hopefully the step 2 helps, but you don't need 250+ to get into gen surg. The boards are used as screening for interviews. Usually they want a 90 or higher on the two digit score. This only gets you the interview, then they look at your grades, letters, etc.

Grr, I HATE screening by numbers; I know it has to work that way, but I dislike it. My step I is only 207/84. I'll take step II in Sept/Oct in hopes of expanding my options. Obviously I'm hoping for the higest score possible, but what am I realistically shooting for?

 

[Masonator]

If the step 2 doesn't work out, you can still have your chairman make calls and get you interviews.

 

[Blade28]

Originally posted by keraven
Blade, have you somehow bypassed the rediculous HMS visiting clerkship application and already know you'll be there? (If this is just positive thinking, I'm not knocking you, just looking for tips.)

Ah, no, no special bypass. Just wishful thinking (and the fact that my schedule is planned around it ).

 

[Vincristine]

Originally posted by Blade28
Ah, no, no special bypass. Just wishful thinking (and the fact that my schedule is planned around it ).

Gotcha, my life works the same way!

 

[TysonCook]

I'm a second year that will have the entire 3rd year and part of fourth year to possibly do some research. As of right now, I have absolutely nothing to put under that heading on my app. I'm somewhat afraid that it might hurt me in the long run, but at the same time, I don't want to "fail" a rotation trying to get published.

Does anyone have any insight as to:
1) the need for research to match a competitive residency (cat gen. surg/ortho)? - (hopefully Denver/SLC)
2) is research possible to do during the third year?
3) Which is more valuble, getting a publication, or doing well on a rotation during 3rd year? - time has to come from somewhere.

I do have other things on my app that are good such as class president, president of several clubs etc. decent grades.

Thanks for any insight as I'm trying to get my 3rd year in order.

 

[Blade28]

Originally posted by keraven
Gotcha, my life works the same way!

 

[aboo-ali-sina]

Originally posted by TysonCook
I'm a second year that will have the entire 3rd year and part of fourth year to possibly do some research. As of right now, I have absolutely nothing to put under that heading on my app. I'm somewhat afraid that it might hurt me in the long run, but at the same time, I don't want to "fail" a rotation trying to get published.

Does anyone have any insight as to:
1) the need for research to match a competitive residency (cat gen. surg/ortho)? - (hopefully Denver/SLC)
2) is research possible to do during the third year?
3) Which is more valuble, getting a publication, or doing well on a rotation during 3rd year? - time has to come from somewhere.

I do have other things on my app that are good such as class president, president of several clubs etc. decent grades.

Thanks for any insight as I'm trying to get my 3rd year in order.

while research is an important adjuct to your application, it can not carry the application. What I mean is that if you sacrifice your Gen Surg rotation (an wind up failing it) for a publication, not only have you not helped your self, you have done yourself a great disservice.

That being said, if you can do research without hurting your grades than by all means you should. Start now, find a clinical chart review, these are labor intensive but they can lead to fast publications unlike benchwork which can take years. Find the surgeons in your school who publish a lot (in my school that was the vascular surgeons) and ask to be placed on a project. You gather all the data, a resident writes that abstract/paper and everyone gets their name on it. If you find someone who publishes alot, they know what the journals want and that makes the whole process easier.

In regards to your other application information, being class president and officer of some clubs is impressive but again does not compensate for the cornerstones of the application with are (not in any particular order) Boards, Grades (especially 3rd and 4th year), and Letters of Recomendation

Also, you should not let any deficiency in one category discourage you from applying to a particular institution. Just because you did not get a 250+ on step 1 does not mean that you have no chance at school X, Y, or Z.

While some schools use numbers as cut off's for applications to be reviewed, usually this is done by the residency coordinator who is not an MD. So if you call or even better one of your Letter writers calls and asks the program director for you to have an interview, your application will then be reviewed by an MD who will take the whole picture into consideration.

Keep that in mind while you are going through the whole process.

Remember
1) It is a process that has many steps
2) No one step or part will determine the outcome in and of itself
3) DO NOT GIVE UP!!!

Good luck....

 

[Toadkiller Dog]

I'd just like to add that I just finished my MS III surgery rotation last week, and the prelims are DEFINITELY treated worse than the categorical interns, even by the categoricals themselves!

I can believe that at some programs that have ENT, ortho, etc programs that get prelims from these might treat them as equals, but our program does not have these, only prelims who scrambled in b/c they had no where better to go. They have the same schedule (I think), but hardly ever go in the OR, and are treated like dirt by *everybody*.

 

[njbmd]

If you are a third-year or earlier medical student who is interested in matching in General Surgery, there are some things that you can do to improve your chances.

1. Score as best you can on USMLE Step I. I know many middle tier programs that will not interview anyone with USMLE Step I scores less than the mean so do well on this exam.

2. Get a good faculty mentor in General Surgery, put your credentials in front of this person and get some good advice. Give your advisor a list of programs (at least 30 if you are not a strong candidate) that interest you. Be sure to apply to your home school program even if you are not going to rank it.

3. Get to know the chairman of Surgery at your school. Surgery chairmen make poor faculty advisors but they should know of your interest in surgery. After you and your surgery faculty mentor have pared your programs down a good solid number, you should allow your surgery chairman to look at that list. Often the chairman can make a phone call in your behalf to the chair of your dream program that will open a door.

4. Do well in your general surgery rotation. You should get Honors here and Honors in Internal Medicine won't hurt your application either.

5. Do an away rotation at a highly ranked program and be prepared to work hard. You may not match there but you may catch the attention of a nationally known surgeon who can write a letter that will open doors for you. This can backfire if you screw up so don't screw up.

6. If you are a first or second year medical student, join your surgery interest group and be active. This gets you in touch with surgical residents and faculty members who can give you good advice, offer you research projects etc.

7. If you are a third-year medical student who had a mediocre USMLE Step I score and grades, take a surgery research elective and write a good paper. Do this elective early fourth year and at least get a published abstract out of your work. This is where having a good relationship with surgery faculty can be golden. You are going to need to do well on USMLE Step II and you are going to need to do some audition rotations if you want to match up.

8. Do well in every rotation. If you have a string of honors during third year, you can greatly improve your chances of matching well. Be sure to get good letters of recommendation from surgeons at your institution who know you well. I have a friend who failed USMLE Step I but is now a categorical resident at a solid academic program. He worked very hard during third year and he posted honors in every required clerkship. He also had the backing of the surgery chairman.

9. Dont' apply to General Surgery programs without a solid letter from the Chairman of General Surgery at your school. If this letter is not in your folder, you won't get many interviews.

10. Finally, talk to some of the surgery residents at your home program especially the interns who are fresh from the MATCH process. Ask them about programs that interested them and about interviews. The residents in your home program can be a wealth of information about this process. We all have buddies in various programs and we can give some insight.

If you have good grades, AOA and stellar USMLE scores, don't rest on your laurels. You may not have to do as much work to match well but you still have to present yourself well.

Good luck to all my "bros" that will be working on matching in the future. Categorical surgery went back into the competitive category this year(totally opposite when I applied two years ago). Do some solid planning and get the career that you want.

njbmd

 

[Vincristine]

Some further surgery FAQ links:

One of the best from the American College of Surgeons: So, you want to be a surgeon: a medical student's online guide to finding and matching with the best possible surgical residency.
http://www.facs.org/residencysearch/index.html
Sections include surgeon traits, residency interviews, surgical specialties, career lifestyle issues, and a fabulous searchable database of all surgical residencys with information provided by the PD's.

Further information for medical students from the American College of Surgeons.
http://www.facs.org/medicalstudents/information.html

The Accreditation Council for Graduation Medical Educaiton
http://www.acgme.org/adspublic/program/
Fully serachable database from the ACGME for any residency with data regarding the number of positions (categorical and prelimiary), number of filled positions, months spent at participating hospitals.

 

[blood&guts]

Anyone have any details on moonlighting for general surgery residents? what about any other ways of making extra money while in residency?

 

[njbmd]

Hi there,
With the 80-hour work week restriction, most residencies do not allow "moonlighting" unless it is during your lab years (seven year residency programs) where you are not seeing clinical patients. Even then, many of my colleagues did not think that moonlighting was worth the risk on their personal medical license and malpractice.
njbmd

 

[Blade28]

My only experience in seeing G Surg moonlighters has been here, at BWH, during my away rotation. And the only residents moonlighting are the ones currently doing their research years.

I think with the amount of work and number of hours put into a regular residency year, it's just too difficult to moonlight. I always thought this was done more by senior residents in IM, FP, etc. (At least, that's what a few IM/FP docs told me. )

 

[Celiac Plexus]

Moonlighting counts toward the 80 hour limit. So, general surgery residents are precluded from moonlighting.

In your research year(s), if you ahve your license, and the permission of the department, you can moonlight. I know residents who have made 50 - 110 dollars an hour covering ERs, and being on-call to run codes. I know one resident who made an extra 150K over 2 years moonlighting.

It is a nice way to make some extra cash, but there are considerations. Making that extra money will push you into a higher tax bracket. You will have to pay more in taxes.

Also, the monetary cost of spending a year or years in research is significant. You get paid say 40K, but you're giving up a year of peak earnings... say 300K/year. So that research year is costing you 260K. Not that this should be a reason to not do research if you want to, but this kind of puts the extra earnign power of moonlighting into perspective.

Good luck.

 

[blood&guts]

Moonlighting counts toward the 80 hour limit. So, general surgery residents are precluded from moonlighting.

In your research year(s), if you ahve your license, and the permission of the department, you can moonlight. I know residents who have made 50 - 110 dollars an hour covering ERs, and being on-call to run codes. I know one resident who made an extra 150K over 2 years moonlighting.

It is a nice way to make some extra cash, but there are considerations. Making that extra money will push you into a higher tax bracket. You will have to pay more in taxes.

Also, the monetary cost of spending a year or years in research is significant. You get paid say 40K, but you're giving up a year of peak earnings... say 300K/year. So that research year is costing you 260K. Not that this should be a reason to not do research if you want to, but this kind of puts the extra earnign power of moonlighting into perspective.

Good luck.

Thanks for the reply Celiac. I have talked to many senoir residents or fellows who did quite a bit of moonlighting when they were doing research. I guess most of these were before the 80hr work week. That is if they reported it. I dont think there is a surgical resident out there that would agree that they are paid enough. One of my fellows last year told me that you can attend confrences set up by drug companies to discuss certain drugs or a certain text and they get your opinion on it. At the end they pay you 100 or so dollars. Anyone heard of this? Bottom line is that ther is plenty of time during the year for a little extra work. I get a full month off a year plus 1 day off a weekend here and there. Unfortunely i live in one of the most expensive cities in the U.S. I just spent 1000$ on my license and another 900$ on loupes so money is quite an issue here. Well thanks all for your input.

P.S. Dre I appreciate your input, but lets try to make this a real forum, not a nother poor quality site

 

[Winged Scapula]

You'll have to check with your residency program. We are prohibited from moonlighting during vacation time or weekends off, as well; only those working in the lab are allowed to moonlight.

Some programs allow you to moonlight if your total hours don't go over 80 per week; others, like mine, do not allow it at all.

As for not reporting it, this would be hard to do, as the institution you'd be moonlighting for would need records/information from your current institution for their files/malpractice insurance coverage.

 

[Leukocyte]

....or is general surgery really "abdominal surgery"?

How involved are they in the head, neck, back, pelvis, and the extremities?

Thanks.

 

[Smurfette]

While it does seem to be mostly "abdominal", gen surgeons often do thyroid & parathyroid surgeries, breast surgeries, lymph node dissections, cyst removals (wherever on the body the nodes or cyst may be). Skin cancer excisions are another common thing that they do. Some do carpal tunnel releases, and some do c-sections/ectopics/ovarian cyst removals (though this is more the OB/Gyn territory). Hernias, spermatocele repairs. In tertiary care centers, some surgeries (like APRs) may involve a complete pelvic dissection and removal of fairly extensive amounts of tissue/organs if due to rectal cancer and the like.

But you're right, pelvic surgeries are usually urology/gyn specialties, and extremities are usually ortho or plastics. Back surgeries are usually g-surg unless it involves the spine (-->ortho or neurosurg). Head/neck are usually neurosurg, ophtho or ENT.

 

[Pir8DeacDoc]

this topic seems to come up fairly often so if you don't get a good response then make sure to search the old threads.

My response to this has always been that a fair amount depends on where you want to practice. I spent summer b/w first and second year working in a small 4 OR, 100 bed hospital. These guys were general surgeons. They did the bread and butter appy, chole, hernias, and bowel cases. However, they also did thrombectomy, AV fistula, thyroid, breast mass, melanoma, etc. My med school is at a ~800 bed facility tertiary care and the general surgeons tend to be more specialized. Cases like AVF and thrombectomy will be handled by the vascular guys, breast and melanoma by the surgical oncologists. Although I have noticed we have one general surgeon who does a fair amount of thyroid/parathyroid, most of the GS guys here do bowel, hernia, appy, chole, cysts, and gastric bypass. So I guess it really just depends where you want to practice and what you feel comfortable doing.

 

[drboris]

Do surgeons (all types) work more than non-surgeons simply because surgeons start their day earlier (7:00am surgery) or is because they work later and are on call more often?

 

[Leforte]

All the above

 

[shag]

All the above

and then some....

 

[delchrys]

this actually seems like a cool thread to do this in...any surgeons out there (residents or beyond) willing to indicate where they are (hospital) and the general weekly schedule they have in terms of call and regular shifts and stuff? and any additional info about their prog? i'm just curious...my gf will be trying to match gen surg this march and i'm trying to get a feel for what we're in for that's slightly less vague and "official" (i.e., falsified) than what's already available.

 

[Celiac Plexus]

my gf will be trying to match gen surg this march and i'm trying to get a feel for what we're in for that's slightly less vague and "official" (i.e., falsified) than what's already available.

I'm not quite sure why you are equating "official" work hours with "falsified" work hours.

The 80 hour mandate has been incorporated in surgery programs across the board. A handful of programs qualified for a few more hours (mostly programs with fewer residents).

Any program that does not comply with the RRC's rule will suffer serious consequences.

Having said that, it's an average. Thererfore, some weeks will be a little longer, and some shorter. But, overall 80 hours is still a long week for any resident. At my program we take call every other weekend and have 2 full weekends off a month. We also have a night float system. Our residents are able to adhere to the 80 hour rule, and our faculty vociferously supports the rule.

 

[Blade28]

I've also seen similar changes due to the new 80-hour workweek limitations. At one of my away rotations, the residents typically work 6-8 M-F, a half-day on one of the two weekend days, and then overnight call every other weekend or so. We also have a night float system here, so no q3 call.

This program, like others, also has an exemption that allows its residents to work an extra 10% (i.e. 88 hours instead of 80).

 

[cak]

most programs in new york/north jersey are q3 for most of the five years. my typical day starts from 5:00 to 6:00AM and goes to usually 5:00 to 6:00PM with maybe one day a week going to 7:30-8:00PM. we get out post-call by 10 or 11AM and we get 2 separate weekend days off every 3 weeks. (NEVER a complete weekend off, i.e. friday night to monday morning, the whole five years). You can do q2 one week to get a q4 over the weekend, but you have to find someone who's willing to do the same thing.
I don't know how it is in the rest of the country, but we definitely work more than 80hrs a week, sometimes a lot more. But most people seem to be ok with that.
I hope this helps.

 

[ears]

... we definitely work more than 80hrs a week, sometimes a lot more. But most people seem to be ok with that.

When you fill out your time sheets, do you fill them out accurately, or do you fudge them to meet the ACGME requirements?

 

[cak]

When you fill out your time sheets, do you fill them out accurately, or do you fudge them to meet the ACGME requirements?

I personally haven't filled one out yet, but I know other residents have been told by the department and the hospital administration to basically fudge our hours worked. We were also required to sign a copy of our "schedule" signifying that we "agree" that those are the hours we are working or supposed to work. So, now even if we a forced to work more than what is scheduled (which on paper is 80 hrs/wk) the department of surgery is no longer responsible. There are definitely ways around the 80-hr work week on paper. Just talk to as many residents as possible during your interviews to get the real scoop on how that program is dealing with the ACGME requirements, and find out if they've had any violations recently.

 

[delchrys]

i have confirmations from a number of sources that the workweek often is well beyond 80 hours or even 88. i keep this info confidential, and simply use it to help my partner figure out which programs she will seriously consider.

 

[dry dre]

i have confirmations from a number of sources that the workweek often is well beyond 80 hours or even 88. i keep this info confidential, and simply use it to help my partner figure out which programs she will seriously consider.

Have you heard of any programs that routinely average less than 80 hours per week?

I don't understand the logic of searching for a surgical residency based on hours. It might make sense if there were issues occuring outside of residency that would require extra time (young children for example).

I say the above as once you finish a surgical residency you will still be working 50-60-70 hours a week. Not to knock your question, but such questions typically come from someone not interested in the surgical lifestyle that continues on after residency. Depending on where you choose to practice, you'll keep up your residency hours while building a practice.

 

[JAMMAN]

When I was a second and third year resident in NY, I worked 120-130 hours every week.

Then as a 4th and chief, the 80 hour work week began to get enforced. The lower level residents were happy to work 80 hours and would leave before the work was done. The senior residents always stayed to get work done and as a result...worked more than 80 hours...but never complained.

The 80 hour work limit has really hurt surgical training. I expresed my concerns to my program director before I left and he said, "They may not know anything, but at least they will be well rested...and that is what the ACGME wants".

 

[delchrys]

as a surgeon friend of mine once told me, "if they can't learn it in five years at 80 hours a week, you're not teaching them right."

 

[JAMMAN]

as a surgeon friend of mine once told me, "if they can't learn it in five years at 80 hours a week, you're not teaching them right."

As a surgeon, I am telling you that your surgeon friend was wrong. There are far more things to learn about being a surgeon than can be learned in 80 hours per week. Of course, you can read about things in a book, but as a surgeon, operative experience counts for alot.

Sick patients don't follow any time schedule and typically the sickest will come in in the middle of the night....when the fewest residents are available...especially now that the 80 hour rule is in effect.

There are many things that I have only saw once as a resident and usually it was in the middle of the night. I am so glad that I saw those things because I am a better surgeon today because of it.

As surgeons, we must know what the right thing to do is and when to do it. We must also have the stamina to perform under stress, exhaustion and pressure. You cannot read about these things in a book. This comes from experience in the hospital. If you aren't there, then you can't learn.

The more you see and do as a resident, the better prepared you will be for your career. There is nothing worse than finishing your surgery residency and not being ready to be a surgeon.

 

[DrDavid]

A junior surgery resident somewhere in PA:
4:00 AM ~ 6:00 AM rounding all ICU patients on my service and some of the more complicated floor patients; usually "SIGN IN AROUND 5:00 AM"

6:00 AM ~ 6:35 AM Meeting with team

6:35 ~ 6:50 bathroom break and breakfast

7:00 ~ 11:30 outpatient surgery/interrupted several times from ICU

11:30 ~ 12:00 lunch & interrupted several times from ICU or attending rounds

12:00 PM ~ 3:00 PM outpatient surgery

3:00 ~ 6:00 rounding all my ICU patients and meeting with my team

6:30 "SIGN OUT"
6:30 ~ 7:30 sign out to nightfloat

7:30 ~ 8:00 finishing up

8:00 PM leave hospital or stay if one of my patients went into the OR

Wkends if not on call:
6 hours rounding patients includ. Sat & Sun

Officially, work under 80 hrs/wk but usually around 90 and frequently >90.

 

[Denial]

I easily go over my hours but I hate to account for it. I mean admit it do you leave hte hospital at 11 post call? If u have had more than one call a week ... there it self you are hazarding a more than 70 hour.

 

[Denial]

i'm sorry, how does this response address the suggestion i made, other than to assume i'm ignorant of what surgical training entails? so you tell me, oh wise one of lots of words but few answers or factual information: why do surgeons continue to maintain a system that requires 80-120 hours of work each week? because it is well-respected? because it is well-paid? or because it is so entrusted with patient care? and how many of those things would change if the number of surgeons tripled? the pay, that's the only element. so, are you saying that adding to the number of surgeons and reducing the hourly workweek would hurt your pocketbook, and THAT is why surgery residents have to work more hours than the mandated limit, and why female surgical residents have an incredibly difficult time taking maternity leave? lots of rhetoric and spitting, but where's the rational basis for your position?

oops sorry I manipulated the thread to reflect the practical ratification of what goes on even after the 80 hour curfew. I just want to belabour that it is impossible to not lie about the 80 hour thing under duress. Surgical residency iunlike anyother faculty behooves you to be in the OR more than the floors. Residents have an axe to grind here. The OR cases they log in the better!!! Surgery fortunately is one those brancehed where you cant get by passive learning (osmosis).. it involves and active effort at a cellular level.
This why the 80 jour will be a farce. By the way I agree with the theory about more surgeons =less hours.

 

[apma77]

80 hrs/week is more than enough to train a surgeon or any other specialty. those who say that you need more than that are either bitter because they didnt get the 80 hr perks from acgme in their time or are just a little slow.
most of those 80 hrs even are spent admitting and doing social work **** in the hospital.

then there are those who state that one shouldnt leave the hospital until the work is done...well......THE WORK IS NEVER DONE! it just dribbles into that next day..patient issues are never ending

 

[jc7721]

80 hrs is enough to train a surgeon. Period. I've yet to find a surgeon who can make the argument that when they worked >100hrs/week, those extra 20+ hours were adding to their training as a surgeon. I hope all the medical students reading this forum, and residents too, realize that during the junior years of residency, we do an enourmous amount of worthless, secretarial, non-patient care related crap. Guess why hospitals are hiring all those nurse practioners and PAs. And guess why they don't hire more; they cost A LOT more than residents. Furthermore, residency programs are not allowed to increase the number of residency spots as they see fit. The RRC/ACGME has to approve an increase based on a number of factors; primarily, will the increase dilute the training of the residents. Here's something else to think about, and not just for surgery: we should not expect a smooth transition to the new work week mostly because the rules are restricting a previously unrestricted process, one that has been around for a long time and had developed a (good or bad) culture regarding enourmously long work hours. It's going to take time. My program still has some problems, but the faculty make changes as needed to fit into the new system, i.e. they actually care. You should look for this when you interview--do they embrace, accept and actively adjust to the 80 hr work week. When you are post call, you must leave by noon (24 hrs + 6) the next day. Period. Anyone who thinks there is an exception to this rule (other than the dying/crashing patient) needs to think twice. We're in the new era of sign-out. We are all going to be passing off A LOT more stuff to the oncoming team, and that is just a fact of life, and we need to deal with it. There will cases that are missed, procedures that are passed off, long lists of scut signed out, and until we all accept this and realize that we're not weak for doing it, there will be problems.

 

[buggs]

Who determined that 80hrs is enough? There's no evidence. Just because a bunch of junior residents and med students say 80hrs is enough does mean its the correct number. The jury is not out on how the 80hr work week is going to affect surgical training. There are plenty of fairly well educated surgeons who have trained residents for years who don't feel it may be adequate. As for extending the training longer--I can't even begin to address that issue.

 

[Blade28]

A resident told me something last week that made a lot of sense (and yet, I hadn't heard it before). He said that the reason the hierarchy/pecking order/totem pole is so strong in surgery, versus other fields (medicine, peds, psych, etc.) is because surgery, almost by definition, is so procedure-oriented. (It doesn't matter if you're talking about a simple line insertion, lap chole or Whipple.) An intern has to respect his/her superiors not necessarily because they're smarter or more intelligent, but because they have more operative experience. It's different in other fields, such as medicine, where fundamentally two people of vastly different backgrounds and experiences can debate any given issue. In surgery, the senior resident has seen so much more than the junior resident, and so usually, the more informed decision stands. Very few people are "born" natural surgeons, so it takes time slogging through residency, fellowship (if applicable), and private/group/HMO practice to really develop those skills.

I guess my point is, often surgeons both bemoan and pride themselves on their grueling residency; many feel that the new 80-hour workweek benefits them the most, since it was the surgery residents that were getting killed working 100-120 hr/wk. As some have stated, there are times when you just can't leave, even though it's noon and you're post-call - patients have to be discharged, or there are complications on the floor/unit, or you're still scrubbed into an emergent ex-lap, or whatever. It's not always a simple matter to simply sign-out to the next shift.

The residents I've worked with, for the most part, really seem to enjoy their job. Of course I may be dealing with a skewed sample, but I've worked with residents in my home state of Hawaii, and during away rotations at USC (LA county general hospital, an extremely busy hospital), and Harvard (BWH, again another very busy hospital). No one LIKES to stay past 80 hours. Believe me, the chiefs don't like it either - there's always pressure coming from above for the program to enforce the ACGME's policies, and no residency program wants to be put on probation. But I think this is something that all med students going into surgery are somewhat aware of - that there may be times when you just have to stay a little later than everyone else. Obviously if it's just scutwork that needs to be done, like checking labs, removing staples/sutures, changing dressings, etc., then those tasks can be delegated.

 

[Blade28]

I forgot to add, I'm a big proponent of residents not working while under extreme sleep deprivation. Though I'm a night owl, and pride myself on being able to get by (and function reasonably well!) on very little sleep, no one wants an exhausted, prone-to-make-mistakes physician, let alone one that's operating on them! Having said that, sometimes it's the post-op problems and complications that keep residents at the hospital when they're post-call, or when it's after sign-outs and it's time for dinner at 8-9 pm. It's not like residents are in the OR 80 hr/wk (though I'm sure some would prefer that to managing patients on the floor ).

 

[daredevil_2010]

Overall I find this thread silly. At my program (MUSC) we are very 80 hour compliant. Some weeks we work more and some weeks we work less. I don't understand why people need to stay beyond 6pm to discharge patients. We usually do this in the early morning. Yes, emergencies do come in and if they come in during a certain time period we stay late. No body complains. However, the night flight team is also there to pick up the slack.

I believe the large majority of Attendings here greatly favor the new 80-hour work week. Contrary to what one would expect, patients get far better care. Residents are very happy here. Happy Residents make learning and operating more productive and fun. Also, I don't think any chief resident is complaing about not getting their same number of cases. They still operate the same amount. When on Nightflight, all your cases are "emergent" cases; thus the argument that outofblood makes... does not make sense to me. Instead of maybe doing 2-3 "emergent" cases a week during your chief year... you end up doing 2-3 "emergent" cases a night for 4 months. At other programs, if a "Rare" case comes in... do all 30 surgery residents hang out in the OR or exam the patrient? Non-sense. We learn about it at grand rounds and M&M... just like they did it in the "old" days.

Finally, surgery is a demanding field, but since we are 80-hour compliant I find other fields working more hours then us. Maybe they don't work as hard, but they do spend more time in the hospital. Working 120 hours vs 80 hours, doesn't necessarily mean you are "learning" 40 hrs worth of material. In fact I could argue you might be learning less.

 

[Seaglass]

Actually, in the NEJM article out this month interns on a traditional schedule made 35% more errors, not 5 times as many errors (500%).

 

[EctopicFetus]

Myth: Long work hours are necessary for Surgical Training

Reality: Much of the time of Surgical Residents is spent doing BS like paper work and dealing with social issues.

Myth: The long hours are totally worthless

Reality: The more time you spend in the hospital the more likely you are to see those rare cases that at some point you will have to deal with by yourself.

Delchrys, not to attack you at all but another VERY important issue to consider is that Peds Surgeons work more hours than General Surgeons. Take a look at the Iserson book about average hours worked by Peds Surg Attendings If I am correct is it almost 70 hours per week AS AN ATTENDING! This is a little something that seems to have been overlooked on this site.

 

[Seaglass]

"serious diagnostic errorrs" was 5.6 times that of a non-sleepy resident.

It was, but the overall numbers in both groups were low - for example you're many times more likely to be struck by lightning on a cloudy day if you walk outside with a large metal pole in your hands than if you just step out to pick up the mail, but in either case the overall risk is low, which is why they still allow those baton twirlers in parades on couldy days.

 

[EctopicFetus]

It was, but the overall numbers in both groups were low - for example you're many times more likely to be struck by lightning on a cloudy day if you walk outside with a large metal pole in your hands than if you just step out to pick up the mail, but in either case the overall risk is low, which is why they still allow those baton twirlers in parades on couldy days.

Well said and very funny.

 

[delchrys]

It was, but the overall numbers in both groups were low - for example you're many times more likely to be struck by lightning on a cloudy day if you walk outside with a large metal pole in your hands than if you just step out to pick up the mail, but in either case the overall risk is low, which is why they still allow those baton twirlers in parades on couldy days.

i appreciate the humor, but i fail to see the relevance of the analogy. if your wife, or life-partner, or child goes into surgery, and your choice was to have someone who is "average" or to have someone who is 10% more likely to screw up, we all know who you'd pick. and we're talking about a lot more than 10%.

since you brought it up, what were the numbers?

 

[Seaglass]

I'll have to wait till I'm back at the hospital to look them up, I'll try to post them tomorrow morning. And your point is well taken, I'm just trying to keep this article from being blown out of proportion.