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surgical specialties competetiveness and an 80 hr week

Discussion in 'Surgery and Surgical Subspecialties' started by ckent, Nov 3, 2002.

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  1. ckent

    ckent Banned Banned

    Jul 31, 2000
    Will all surgical residencies become more competetive with an 80 hr rule being enforced? I think that it will. I think that there are a lot of people that choose fields other then surgery simply because they are unable to tolerate a 100-120 hr week in the OR. With 80 hrs, your surgical residents will be working as many hours as your internal medicine residents and your psych residents, and etc. Most surgeons make more then the average non-surgical physician, and we all know that med students, on a whole, follow the money. By taking the time factor out of the equation, I think that there will be a lot more people looking at surgical careers. And since there will be more people looking at surgical specialties as a career, it will become more competitive. Thoughts?
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  3. jt999

    jt999 Member 7+ Year Member

    Oct 5, 2002
    New York
    When was the last time you saw an IM or psych resident work 80hours/week?

    I'm not sure how the new laws will affect working hours. In NY, we already have those laws and all it means is that the residents write they work 80 hours/week when they work 100-120.
  4. womansurg

    womansurg it's a hard life... 7+ Year Member

    Aug 19, 2002
    I guess my own inclination was to think along those same lines, ckent. After all, surgery is amazingly interesting, fun, fulfilling... Practically the only drawbacks have been the lifestyle and the abusive training. With those being moderated, I would think that a lot of folks who were siphoned off by 'gentler' surgical subspecialties would now be inclined to stick with gen surg.

    For instance, one of our interns left to go to ENT, and sheepishly admitted that he thought the practice would be not nearly as interesting ('sucking snot' he called it...), but this way he could still do surgery while having time to see his newborn grow up during his training.
  5. tripod

    tripod Member 7+ Year Member

    Apr 17, 2002
    whoah that's amazing
    there was actually an opening for an ENT spot available?
  6. womansurg

    womansurg it's a hard life... 7+ Year Member

    Aug 19, 2002
    Yeah, this guy was a real sharp competitor - stellar numbers, great recs, etc. Apparently he had looked into ENT before deciding on gen surg, and was already somewhat known in that community. I'm not sure if they had an opening or just made a position for him or what, to be honest.
  7. ortho2003

    ortho2003 Senior Member 7+ Year Member

    Mar 18, 2002
    I think the same people that don't want to work the crazy hours of a surgical subspecialty during residency will not want to work the 60-70 hours they work when in practice. I doubt you will see many more apps.
  8. samsonlee

    samsonlee New Member

    Nov 27, 2002
    working 80 hours a week seems good, but all it does is make you less of a surgeon, your case load goes down by 1/3, thus the inevitable result is they are going to make residency longer, I'd rather suck it up; if you don't want to work, you shouldn't become a surgeon
  9. Winged Scapula

    Winged Scapula Cougariffic! Staff Member Lifetime Donor SDN Chief Administrator 10+ Year Member

    Apr 9, 2000
    hSDN Member
    samsonlee -

    Just wonderin' where you're getting the data that your case load "will go down by 1/3" with the reduction in work hours?

    I don't know where you are in your training, but as its been noted here time and time again, a large proportion of the 80+++ work hour weeks are NOT spent operating (even for the Chiefs) but rather often doing things with little educational value (especially for the junior house officers) - things like WAITING for the OR to start, WAITING for patients in clinic, WAITING for the Chief to get out of the OR (on a case which you couldn't scrub because there were already too many people in there) so you can round, WAITING for labs to be drawn, sent, analyzed, removing rectal tubes, chest tubes, etc. (which are of little value after the nth one done), etc.

    We are doing much less call now (average of q5 on most rotations) in an effort to reduce the hours (its still more than 80 on most rotations) so in effect, even though we're going home post-call at noon, we're only missing 1/2 day a week of potential OR time - hardly 1/3 of the training.
  10. How do you figure case load drops by 1/3? That sounds like an old school surgery attending statement as to why everyone should live at the hospital. Just to echo the sentiment with a quote:

    As for competitiveness:

    While the number of applicants may be on the rise, I suspect the number of ?traditionally? competitive applicants is about the same. I may be wrong, but, the number increase is probably secondary to an increase in the foreign grads and the bottom pool of US grads. If you would have been competitive last year or the year before, you are likely to be just as competitive if not more now. The increasing applicant pool will be filling out the community programs and on occasion the unmatched university spot.
    Last edited by a moderator: Aug 30, 2008
  11. womansurg

    womansurg it's a hard life... 7+ Year Member

    Aug 19, 2002
    I've beat this drum before...

    It is FAR more often the university programs rather than the community programs which
    1. fail to fill
    2. have to scramble
    3. fill spots with FMGs
    4. have residents score poorly on the ABSITE

    I'm from Iowa Methodist Medical Center. We take 3 categoricals per year. The average board scores of our accepted interns is 240. This year we have three applicants with scores in the 250 to 260 range. AOA is typical. We get the top people from the regional medical schools, while the U programs sometimes go unfilled. It was the same way when I was a student at Ohio State.

    We don't have to look beyond the top 5 of our rank list to fill and we've never taken a FMG or a DO (sorry - I don't personally agree with this policy). About half of our residents score above 90th percentile on absites. We graduate with >1200 cases and folks wanting fellowships have been very competitive (my classmate matched into plastics this year and had his pick of programs).

    The people we take could easily match at Mayo or U of wherever if they so desired; they choose our program for the many benefits and relatively fewer detractors that it offers. Don't buy the propagana that your university biased surgery departments feed you - look into the facts for yourself.

  12. droliver

    droliver Moderator Emeritus 10+ Year Member

    May 1, 2001
    In fairness, I don't know that's the case across the vast majority of community programs across the county. Your program in Iowa tends to pull a self-selecting & non-representative pool of applicants because it is a very good (one of the best I'd submit) community programs. It's also a little hard to compare the match rate and how far your rank list goes b/w programs as you're talking about ones that range b/w one resident & sometime 10 or more a year (ours is 8 & applying for 9). The majority of categorical spots unfilled last year also continue to be from private programs.
  13. southerndoc

    southerndoc life is good Moderator Emeritus Lifetime Donor 10+ Year Member

    Jun 6, 2002
    The 80-hour workweek should raise the numbers for USMLE, grades, etc. if it causes more applicants.

    If one examines those programs that have less rigorous call schedules, less weekly time demands, etc., then you would notice that they are the most competitive. I'm speaking of dermatology, radiology, emergency medicine, etc.

    An influx of these applicants into the general surgery pool should cause the mean USMLE scores, grades, etc. to increase.
  14. droliver

    droliver Moderator Emeritus 10+ Year Member

    May 1, 2001
    Actually, a larger sample size (in this case applicants) usually tends to bring the average of whatever you look at down. Also there is a tendency for many people going into surgery to look @ the quality of the training or prestige of a program over "lifestyle" issues. For an oppurtunity to train @ the best programs, many would accept the trade offs that go with that. As you get away from those top programs and the presumed benefits they'd have on your career, I think the other factors come more into play. With the contracted applicant pool, those programs have to sell themselves more & make some of these concessions more than ever in order to attract people to come
  15. I can not speak to many community programs, but I know enough about Henry Ford & William Beaumont to agree with you.

    I have seen lousy surgeons and spectacular surgeons at both university and community. When I was doing internship at a university program, nurses routinely said they would only go to the community hospital down the street for surgical care!!! It just depends on the program and what it looks for in its staff.

    Turnover is often a matter of financing, ancillary care, and politics, etc... Does your hospital have a union for nurses? Unions can sometimes slow down your OR. Does your hospital have enough nursing/OR staff? I do not think I would say turnover is strictly split U verse community.

    I think traditionally you get earlier and more OR time in community programs verse university programs but I can't say I have any studies to back this statement.

    just my opinions and experience.
  16. droliver

    droliver Moderator Emeritus 10+ Year Member

    May 1, 2001
    Operating room turnover time @ University hospitals has been frequently identified as a large potential problem facing surgery with the new work hour regulations. The problem as I see it is a lack of financial incentive and the fixed shift schedules for the various people involved.... the nurses,scrub techs, anesthesiologists & crna's , housekeeping etc.... None of them have the same agenda as I have- that being starting cases on time & minimizing turnover time in order to get more work done. The more efficient things are, the more work there is for them is the way they seem to feel about it. In addition, as things drag on they frequently get paid overtime if they stay beyond their normal shift hours. This tends to be less of an issue @ private hospitals as there are stong financial incentives of the hospitals and anesthesia groups to be cost-effective, in addition to the fact that they get to go home when things are thru.
  17. Hey, pba: You can always edit your reply once posted if you want to...just use the edit button underneath it.
  18. In general, I would agree with the statement "the more you operate, the better you get". However, the rules are a little more complex then just numbers. There are a certain number/percentage of your cases that must be of certain types and you must be a "senior" surgeon for a certain number/percentage. That is why in many programs you spend up to 12 months on a general surgery service during your PGY5/chief year.

    Just a thought for you, placing a 3 lumen central line is a procedure, placing a broviac in the OR is a "case". So, numbers without description do not give the full picture. The question is how much of that 1500 cases would be described as "major"? Nobody finishes with 1800 major cases as a "senior surgeon".

    I suspect any attempt to limit the total number of cases you finish with is an effort to streamline and ensure you:

    1. get the specific number of complex cases you require and to keep you in the big cases and not sent as a chief to do a lipoma resection
    2. by streamlining and ensuring your training is based on a thought out plan (as opposed to luck of the draw), you can also prevent overworking residents and enhance training....in theory.


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