The 80-hour work week ...I wish I had a clue.

[kinetic]

My random musings on the 80-hour work week:

Is an 80-hour work week intrinsically "good" or "bad"? It seems that a lot of people think it is. If you are FOR it, you argue that "more hours doesn't mean better training", "we're not slaves for the hospital to use", and "fatigue leads to mistakes". If you are AGAINST it, you argue that "the new breed of doctors are lazy", "you need the hours to get the needed experience", and "we did it, so you should too".

And you know who is on which side (often). Attendings and upper years who went through the 120-work week are usually anti-hour restrictions. Juniors levels and interns are generally more pro-hour restrictions. This has, in my VERY limited experience, led to friction between the two.

I have heard attendings say, "yeah, I'm not for the 80-hour work week, but that's what we've come to with the new generation of physicians". And chiefs who have said, "I worked 120-hours/wk while doing research ...I don't want to work with anyone who can only hack 80 hours". (By the way, if non-medical people heard that comment, I think their heads would spin like on 'Poltergeist'.) I can certainly sympathize with that viewpoint. If I got reamed in training and then saw people basically getting a perceived white-glove treatment, I would be a little steamed too. But isn't that also the basis of hazing (NOT that I am saying they are exactly the same thing)? "I got my butt paddled in a cemetary for eight hours and then left naked to find my way home, so now it's my turn to be the paddler"?

I'm torn because I feel a) guilty that I'm not "strong" enough to take 120-hours/wk (yeah, I've bought into that argument) and b) sad that I won't get to see as much stuff go down as people in the past. On the other hand, I also still think that "more is better by definition" is also a lame argument. What do you guys think?

---

Members don't see this ad.

 

[aboo-ali-sina]

The answer to you question "Is an 80-hour work week intrinsically "good" or "bad"? " is all dependant on the specific program you are reffering to.

If you go to a program that has adapted by providing allied health professionals to do the non-educational work associated with residency (i.e. hunting down x-rays, labs, transporting patients, etc) that was so much a part of the old training programs, then the 80 hour work week may not be so bad. Especially is on top of the allied health professional help, the program has also increased its emphasis on education, incorportated lectures, wet labs etc.

Now if you are restricted to 80 hours in an environment where the interns are orderlies then it is not so good, because it is detracting from your education

those are my 2 cents

 

[Amy]

Are surgery programs actually complying with the work hour laws?

 

[Harrie]

Its not just attendings and upper-levels who dislike the work hour restrictions. I know quite a few junior residents who wish that they could work more. They feel like the rules restrict their ability to learn. Honestly, I can see that point. Not that anyone would really say, "Hurray, another 120 hour week", but when they are forced to go home (which does happen...sometimes) when they are involved in a good learning experience it sucks. Plus the interns (who are the social workers, nurses, paper work masters, etc) already have limited OR time...limited even more by work hour restrictions. I'm not saying that this is my viewpoint, but this is how many surgery residents that I've met feel about these new restrictions. (please note, I did NOT say all surgery residents)

 

[Foxxy Cleopatra]

If you are interested in seeing what it is like to work in excess of >100, don't worry, many programs still far exceed 80 hours. More than that, watch your attendings. Yes, some do have "cush" jobs but many of our attendings work as much (if not more) than we do. In other words, some of the old work hours are still alive and well.

As a resident, I have mixed feelings. Here's my dilemma:

1. I hate scut. I have worked, well let's just say *many* hours per week on a few services doing purely mind-numbing mundane work. However, I don't think I would like dealing with the social work issues even if it was only for 40 hours a week.

2. On the other hand, patient care doesn't follow a time clock. I have seen a few people who think that it does and will not see patients/take care of them "off hours." I have sacrificed more than one day off to go in and do a procedure that the primary team would not do because "it's Saturday afternoon." This is because I do not like subpar patient care.

In the ideal world, there would be a balance between limiting scut (making hours at the hospital more productive/educational) while maintaining the work ethics to provide the best patient care.

That's my $0.02

 

[joedogma]

I think it is debatable whether or not the level of patient care is improved with the new regulations. You can make an argument either way and every doctor has a different size gas tank. That said, these new rules are somewhat protective for the residents. If you have the misfortune of screwing up royally, I can't think of a jury that would be able to understand that you haven't slept for 48 hours and still took a knife to someone's belly. Now this may not have been such a problem years ago but the medical field has become so litigous and the plaintiff lawyers have become so good at tearing down doctors, they will exploit such working conditions to their benefit. Since it is usually the attending who is going to bear the brunt of the burden of a lawsuit, I don't know why they would WANT such a potential liability in the OR with them. Nothing like an enlarged ego the cloud judgement...

 

[maxheadroom]

I think that I've learned plenty working 80 hours per week. My program has been fastidious about adhering to the rules.

Sure, attendings work lots and there are no regulations on their work hours. Should they be working >80 hours per week? Probably not. Should they be regulated? No. Will I work that much when I'm out in practice. No way.

The difference is that our generation puts a bigger priority on personal life. I'll sacrifice income in order to have time for my life.

 

[Masonator]

My random musings on the 80-hour work week:

Is an 80-hour work week intrinsically "good" or "bad"? It seems that a lot of people think it is. If you are FOR it, you argue that "more hours doesn't mean better training", "we're not slaves for the hospital to use", and "fatigue leads to mistakes". If you are AGAINST it, you argue that "the new breed of doctors are lazy", "you need the hours to get the needed experience", and "we did it, so you should too".

And you know who is on which side (often). Attendings and upper years who went through the 120-work week are usually anti-hour restrictions. Juniors levels and interns are generally more pro-hour restrictions. This has, in my VERY limited experience, led to friction between the two.

I have heard attendings say, "yeah, I'm not for the 80-hour work week, but that's what we've come to with the new generation of physicians". And chiefs who have said, "I worked 120-hours/wk while doing research ...I don't want to work with anyone who can only hack 80 hours". (By the way, if non-medical people heard that comment, I think their heads would spin like on 'Poltergeist'.) I can certainly sympathize with that viewpoint. If I got reamed in training and then saw people basically getting a perceived white-glove treatment, I would be a little steamed too. But isn't that also the basis of hazing (NOT that I am saying they are exactly the same thing)? "I got my butt paddled in a cemetary for eight hours and then left naked to find my way home, so now it's my turn to be the paddler"?

I'm torn because I feel a) guilty that I'm not "strong" enough to take 120-hours/wk (yeah, I've bought into that argument) and b) sad that I won't get to see as much stuff go down as people in the past. On the other hand, I also still think that "more is better by definition" is also a lame argument. What do you guys think?

Kinetic you should be ashamed of yourself! Not only are you not strong enough to take a 120 hour week, I think 80 is too much for you! You are so lazy you couldn't handle a 9 to 5 with a long lunch and extra breaks! You won't see anything go down anyway because when you are on call, word will hit the streets and the ambulances will put themselves on divert to other hospitals!!

 

[kinetic]

when you are on call, word will hit the streets and the ambulances will put themselves on divert to other hospitals!!

Doesn't that mean I win?

 

[Masonator]

Doesn't that mean I win?

Soudes has 48 hours to reply to your hatin', if he doesn't then the duel is forfiet and you are the winner. That means General Surgery will be deemed "better" by the playa hata accredidation committee.

 

[kinetic]

No, I meant if all the ambulances go on divert, that means I win.

 

[ortho2003]

intern here who feels the 80 hours is too restricting and hurts my education. I am in a hospital with outstanding ancillary staff, so we have virtually no scut, so it isn't that I am too busy with scut to get an education during the 80 hours. I get a good education during the 80 hours, but I often have to go home and miss cool cases because of the restrictions. The problem with 80 hours is that it was a number thrown our arbitrarily without any evidence to prove that this is a reasonable number. Limiting hours is important...I doubt there are many people out there that think 120+ is reasonable, but there are many, junior and senior residents, who think 80 is too tight. I think a number closer to 100 would allow for ample education and ample rest....maybe with time, the acgme will lighten up a bit, but for now, we are stuck with it.

 

[Masonator]

No, I meant if all the ambulances go on divert, that means I win.

Actually it does. Damn I hate it when I have a hatin' mishap! Sceet! Sceet!
Sceet! Sceet!

 

[Mirror Form]

I think it's hard to determine whether it's better or worse for patient care. Personally though, if I need an operation, I'll be glad we have an 80 hour work week in place. Also, the 80 hour work week is a lot more humane for the residents. Times are changing, and the 120+ hour work week doesn't fit well with our current society.

 

[SRBtP]

At the beginning of the year, I was in love with the 80 hour week. I really was. Then, slowly, a few realizations sunk into my mind as well as the minds of my fellow interns. Don't get me wrong - I still love the fact that I leave after rounds post-call and that I get a night out a week. But sometimes the right thing to do is to stick around. Signing out tons of scut is bad form. A post op check at midnight can be signed out. A coag draw at 6:30 shouldn't be. Sometimes patients are sick. Sometimes you can't leave the unit on time, go home and look at yourself in the mirror. I have returned to the hospital at least a half dozen times this year to do nothing more than sit with a DNR patient as they die.

Yesterday, I stayed until eleven operating. Someone came in to relieve me, but I didn't want to leave - I had sewn an anastomosis on a bypass, and I didn't want to go home without getting a good Doppler in the PACU. Not a huge deal, not altruistic, but sensible and self-serving, to an extent. When I got home, the lady with whom I had to break a date demanded to know why I stayed late. I told her that it was because I was a doctor, and sometimes there's doctor stuff that needs to be done late at night.

I'm glad I'm not sticking around for no reason when I'm exhausted, and I'm glad that I have my printed schedule to fall back on when I really, really can't stay any longer. But I'm more than willing to violate the rules when it's simply the right thing to do.

 

[Apollyon]

I'm glad I'm not sticking around for no reason when I'm exhausted, and I'm glad that I have my printed schedule to fall back on when I really, really can't stay any longer. But I'm more than willing to violate the rules when it's simply the right thing to do.

That's why it's 80 hrs/week, averaged over 4 weeks.

 

[dr.evil]

I have to admit that before the beginning of this year I was very adamant that this 80 hour work week was a bunch of crap. I thought they were going to kick me out of the hospital at hour number 80 and I hated that idea.

I was wrong (holy crap, a surgery resident admitting being wrong!)

Our program went with a night float system which has worked out great. We also don't check out our patients and take calls on them 24/7. Therefore, we always know what's going on with our patients and we operate from 7am - 5pm everyday (no going home early post call). This works out so we have continuity of care, we operate the same amount, and if we're scrubbed into a big case or need to stay late, we don't screw up our hours.

The only true negative about the 80 hour work week at my program is that I truly believe it has made me weaker mentally (but a little better academically). If I'm not out of the hospital by 7pm I think somethings wrong. When I work 30 hours straight now (on weekend call), I struggle a little more than I did last year just because my body is not adjusted to the hectic schedule.

I'm just glad I got to go through the old way of 120 hour work weeks. Looking back, it made me better even though it sucked at the time.

 

[kinetic]

Hey, SRBtP, I admire you - that kind of mentality is what gains respect in my book.

That being said, I still crack up thinking of you looking your not-date in the eye and saying (with a full orchestra in the background), "Baby, I'm a doctor ...and sometimes (music swells and dramatic pause) there's doctor stuff that needs to be done late at night." Cut to you doing a rectal exam on an intoxicated, homeless trauma patient. (Why, God? WHY?!?!?)

 

[SRBtP]

Of course it was melodramatic and hackneyed. If I hadn't turned the emotional manipulation factor to maximum, there's no way I would have gotten away with standing her up. No way at all.

 

[DoctorDoom]

Is an 80-hour work week intrinsically "good" or "bad"? It seems that a lot of people think it is.
And you know who is on which side (often). Attendings and upper years who went through the 120-work week are usually anti-hour restrictions. Juniors levels and interns are generally more pro-hour restrictions. This has, in my VERY limited experience, led to friction between the two.
I'm torn because I feel a) guilty that I'm not "strong" enough to take 120-hours/wk (yeah, I've bought into that argument) and b) sad that I won't get to see as much stuff go down as people in the past. On the other hand, I also still think that "more is better by definition" is also a lame argument. What do you guys think?

I don't think it's intrinsically good or bad, but rather on the degree of training and the junior resident's attitude. You get a well run program with excellent clinical exposure, then 80 hours is great. Juniors who get upset because they want to go to a massage at 830AM post-call without signing out, start whining about the rules, not so good. More is definitely not always better. I am one of the guys who did residency without hours restrictions and am very happy that changes have taken place. Doesn't stop me from talking smack at guys who haven't done the 145-hour work weeks, but that's just to win the pissing contest than anything else.

Don't worry about not seeing as much, find a way to make up for it; I suggest reading more, it may not make up for learning on the hoof at 3AM without having read anything about the disease/procedure at all, but it's better than nothing. It's five years, so you'll have plenty of chances to steal cases from juniors later.

 

[Conquistador]

I think it's hard to determine whether it's better or worse for patient care. Personally though, if I need an operation, I'll be glad we have an 80 hour work week in place. Also, the 80 hour work week is a lot more humane for the residents. Times are changing, and the 120+ hour work week doesn't fit well with our current society.

5(days in a week)*24 = 120; yeah, current society likes sleep.

 

[DoctorDoom]

5(days in a week)*24 = 120; yeah, current society likes sleep.

Last time I checked, there were 7 days in a week.

 

[sacrament]

Last time I checked, there were 7 days in a week.

I think the point is that, to put this into a mind-numbingly horrifying context, working a 120 hour week is akin to working for five days straight without stopping.

 

[DoctorDoom]

Ahhhh... I see. Knew I was missing something. Thanks.

 

[supercut]

I'd say whether it's good or bad depends on how your program accomodates it.

My program has made extensive use of PA's. 7 of my rotations this year have PA coverage. In general, these PA's are very aggressive and seem themselves as superior to the residents. They don't come in early enough to write the morning notes. So the residents see the pts in the morning, write notes, round as a team and come up with a plan. Then the PA's arrive, so we try to run the list with them. They sometimes listen, sometimes don't, and do whatever they want anyway. They've been know to say "we don't report to the residents" They do not want the interns around, and they don't welcome the interns presence on the floor.

Individually, they decide there are things they don't want to do. Often they wont' do admission paperwork. Sometimes they neglect to do discharge paperwork but go to the OR in lieu of the intern (this happens on consults that the PGY 2 is seeing and notifies the attending. The PA trots off to the OR and leaves the floor scut to the intern. But they generally won't allow the intern to run the floor. The floor nurses often won't even direct any issues to the intern.

So often the interns have no intern level cases, and they are chased off the floor by the PA. They wind up learning nothing.

I rotated at some programs where PA's were part of the team, and realized they wer ethere to supplment/assist the interns. In that context they are good. But when they try to become replacements to the inters, it's a huge problem.

Programs need to be very careful and clearly define the role of PA's before they start hiring any. Because they can very easily hinder resident education.

 

[kinetic]

What is a PA doing in the OR, period? They're not there to receive training; the intern is. Shouldn't the attending kick their ass to the curb? And if I was the intern getting scutwork while some PA was in the OR, I'd ram the chart up their butt in a sterile fashion.

 

[DoctorDoom]

My program has made extensive use of PA's. 7 of my rotations this year have PA coverage. In general, these PA's are very aggressive and seem themselves as superior to the residents. They don't come in early enough to write the morning notes. So the residents see the pts in the morning, write notes, round as a team and come up with a plan. Then the PA's arrive, so we try to run the list with them. They sometimes listen, sometimes don't, and do whatever they want anyway. They've been know to say "we don't report to the residents" They do not want the interns around, and they don't welcome the interns presence on the floor.

Individually, they decide there are things they don't want to do. Often they wont' do admission paperwork. Sometimes they neglect to do discharge paperwork but go to the OR in lieu of the intern (this happens on consults that the PGY 2 is seeing and notifies the attending. The PA trots off to the OR and leaves the floor scut to the intern. But they generally won't allow the intern to run the floor. The floor nurses often won't even direct any issues to the intern.

So often the interns have no intern level cases, and they are chased off the floor by the PA. They wind up learning nothing.

Is anything being done? Have the residents brought these very serious issues in their training up to the program director?

 

[kinetic]

The residents should stalk the PAs like ninjas of olden times, systematically wiping them out without a trace. When new PAs are hired, repeat as needed until they know their place (yes, I said it).

 

[supercut]

Alas, many such complaints and meetings have been held, to no avail. The attendings with whom this happens are always present in the OR when PA is scrubbed. After the PD talks to the attendings, it stops briefly, but then it starts again. This mainly occurs on one service. That service is a big CF, if you get my drift. The PA's bat their eye innocently and say "oh, I'm just doing what Dr Attending tells me to". Dr Attending has been talked to multiple times but the problem continues. Drives me nuts.

 

[kinetic]

Complaints and meetings = time to screw residents over. That's what programs do to make you think some action is being taken when the reality is the attendings are sitting around guffawing about "what a buncha losers our residents are ...do you think they bought it?" And all the gullible residents are like, "let's give the program time ...I mean, it seems like they really are open to a discussion of our issues ..." And five years later you leave with a humongous case of stress gastritis and a fist-sized hole in the call room walls.

Did you ever try my ninja suggestion?

By the way, if the PA is only batting one eye innocently, that may be a neurological condition. My eye!

 

[DoctorDoom]

Just stop covering those attending's patients. No cases, no coverage overnight, no meds orders, nothing. That will change things right quick.

Or go ninja.

 

[Fritz]

Regarding the many hours a week issue I will tell you this story from the perspective of the patient. I went to Stanford for a procedure. I knew that Stanford was a teaching hospital and that I would be very likely to find overworked residents. The doctor thought that I should get an epidural, so I agreed to get one. When the anesthesiologist came in, he looked like a ghost. I asked him how long has it been since he had not slept. He told me 24 hours, but I thought it was more. I called my doctor and I told her to get me someone who has been in the hospital less then 10 hours. I did not want someone who had not slept for a day giving me an epidural. I bet that there are many patients out there who, if they heard that their doctor has not slept for more than 20 hours, would refuse treatment from that doctor. The hospitals, however, don?t make this information public, and I think they should. Would you like someone who has not slept for a day going with a knife at your brain? I sure wouldn?t!

 

[Annette]

For the PA issue, why doesn't the intern just go in and scrub, and tell the PA he/she is needed on the floor?????? "I'll take over for you here, sweetheart!"

 

[Intubater_X]

Yeah, kick that "physician extender" to the curb where they belong!