Why are they lifting the 16 hr work limit? Last chance to let your voice be heard.

[Waldeinsamkeit]

https://www.theatlantic.com/health/...rk-30-straight-hours/510395/?utm_source=atlfb

I just saw this article. They are lifting the 16 hr work limit on residents and returning it to 28 hours. Is there anything we can do to stop this? Does anyone know what the AMA's stance on the issue is?

Thank you.

They are still accepting comments from the public until December 19th.
http://www.acgme.org/What-We-Do/Accreditation/Common-Program-Requirements

---

Members don't see this ad.

 

[Levo]

Let's be honest, "work hour restrictions" just means "do all of your documentation from home." It would be much more reasonable to cap admissions, surgical cases, or whatever your given specialty would count by.

 

[Perrotfish]

https://www.theatlantic.com/health/...rk-30-straight-hours/510395/?utm_source=atlfb

I just saw this article. They are lifting the 16 hr work limit on residents and returning it to 28 hours. Is there anything we can do to stop this? Does anyone know what the AMA's stance on the issue is?

Thank you.

They are still accepting comments from the public until December 19th.
http://www.acgme.org/What-We-Do/Accreditation/Common-Program-Requirements

No, there is nothing you can do to stop this. Its like asking the bank not to foreclose on your house.

 

[Hangry]

This again...

1. This isn't "resident" work hour restrictions. It is INTERN work hour restrictions. All residents from PGY-2 on can work 24 hr shifts regardless of this rule change.

2. There are very good reasons for certain subspecialties (primarily surgery) to want interns to have their 24 hour calls back. If you want to know why, respond to this post and ask and I will explain. I don't want to clutter up this current post with all of them in hopes that people don't miss the main points. Essentially, the FIRST trial (run by surgeons) showed no worse outcomes for programs where interns could work 24 hr shifts and this scheduling change is allowing surgery programs to go back to the more flexible hours. It is is no way mandating that your medicine/whatever residencies have to switch back to 24 hour shifts for interns.

3. The rest of duty hours REMAINS IN EFFECT. This means no more than 80 hrs per week averaged over 4 weeks, average of 1 day off in 7, etc and all the helpful duty hour changes that happened back in 2003 or so will stay the same. NO ONE is advocating going back to the good old days of constant 100 hr weeks, living in the hospital, etc.

In b4 a bunch of angry preclinical students shout down the aforementioned points because LONG SCARY SOUNDING SHIFTS ARE ALWAYS BAD AND THEY ARE TRYING TO MAKE US SLAVE LABOR!!!11!1!1!!

 

[Hangry]

Let's be honest, "work hour restrictions" just means "do all of your documentation from home." It would be much more reasonable to cap admissions, surgical cases, or whatever your given specialty would count by.

They already do this.

 

[ACSurgeon]

Let's be honest, "work hour restrictions" just means "do all of your documentation from home." It would be much more reasonable to cap admissions, surgical cases, or whatever your given specialty would count by.

They already do this.

The thought of having a cap on our acute care surgery service...

 

[Hangry]

The thought of having a cap on our acute care surgery service...

I was referring to medicine residencies, where there are caps of patients numbers an intern can carry and caps on the number of admissions they can do per call day (extra patients go to hospitalist teams), I did not mean to imply that every residency employed caps on admissions for every service.

 

[Levo]

I was referring to medicine residencies, where there are caps of patients numbers an intern can carry and caps on the number of admissions they can do per call day (extra patients go to hospitalist teams), I did not mean to imply that every residency employed caps on admissions for every service.

Exactly! There need to be a set of rules coming from the ACGME on admissions just like there is for work hours. It's neither fair nor safe that an IM intern caps at 10 patients while a gen surg intern ends up covering 20+.

 

[Hangry]

Exactly! There need to be a set of rules coming from the ACGME on admissions just like there is for work hours. It's neither fair nor safe that an IM intern caps at 10 patients while a gen surg intern ends up covering 20+.

I do not agree. Very different demands/patient populations. The individual residency boards are much better situated to handle these issues than the ACGME.

 

[Perrotfish]

Exactly! There need to be a set of rules coming from the ACGME on admissions just like there is for work hours. It's neither fair nor safe that an IM intern caps at 10 patients while a gen surg intern ends up covering 20+.

They can publish as many rules as they want, no one is following them anyway. There are no actual work hour limits. There are only two rules that really matter in residency:

1) Student loan debt isn't dischargeable in bankruptcy

and

2) Residencies are exempt from anti-trust legislation

Residencies can collude to make sure you can't find a new job if you quit your residency. The government's loan rules mean you can't quit the profession without ruining your life. So they own you. They can work you as hard as they want, pay you as little as they want, and treat you any way that they'd like.

 

[Levo]

I do not agree. Very different demands/patient populations. The individual residency boards are much better situated to handle these issues than the ACGME.

I'm not saying the rules have to be the same for every specialty. However, I feel strongly that the ACGME should make sure they exist and are reasonable for every specialty. I've seen some very concerning patient to intern ratios.

 

[ACSurgeon]

Exactly! There need to be a set of rules coming from the ACGME on admissions just like there is for work hours. It's neither fair nor safe that an IM intern caps at 10 patients while a gen surg intern ends up covering 20+.

You'll never find a surgical resident wishing to cap the number of patients or limiting the number of cases. Especially not limiting the number of cases. We pride our selves on getting it done. We love operating.

Sometimes it overwhelming for a moment and you wish you could get a break (esp from the non-op BS), but then you don't and you get it done!

 

[neusu]

They can publish as many rules as they want, no one is following them anyway. There are no actual work hour limits. There are only two rules that really matter in residency:

1) Student loan debt isn't dischargeable in bankruptcy

and

2) Residencies are exempt from anti-trust legislation

Residencies can collude to make sure you can't find a new job if you quit your residency. The government's loan rules mean you can't quit the profession without ruining your life. So they own you. They can work you as hard as they want, pay you as little as they want, and treat you any way that they'd like.

This is more relevant than most people believe. Residents are literally financial indentured servants at the whim of the cartel we call the ACGME. We can sugar coat it all we want, but when a nurse graduates an associates degree training program from community college and makes more than a resident with college and medical school; providing less hours and less skilled work, something is unfair. While duty hours are a small subset of the issues at hand, simply paying residents for the work they do, at a fair standard, would likely be the necessary pressure applied that the system requires. Ask any department in any hospital why they can't replace residents with midlevels and the answer, plain and simple, is it would be prohibitively expensive.

 

[Spectre of Ockham]

It's stupid , simple as that. Barring surgeries extending over schedule no one should work more than 12 hours in a row with two breaks included. The US just loves to work doctors like slaves and lower patient care bellow the level of 2nd world countries.

 

[Spectre of Ockham]

Also I'd like to see a doc that sees 50 patients in a shift and claims he was 100% sure he provided equal quality care to all of them . Treating doctors like commodity is done be profit seekers or number crunchers who only get treating in private practices by attendings with both free time and money to burn you know so they don't make any mistakes on the 9 figure per year patient.

 

[mvenus929]

I'm not saying the rules have to be the same for every specialty. However, I feel strongly that the ACGME should make sure they exist and are reasonable for every specialty. I've seen some very concerning patient to intern ratios.

The reason there are separate RRCs for each specialty is because each specialty is different. And some programs pride themselves on not following strict guidelines so that you are prepared when you leave residency.

Case in point... my program doesn't have caps on patients. If a service gets busy, we collectively chip in to help out. That sometimes means that the interns are rounding on 15+ patients in the morning. But, one of my coresidents just applied for a Hospitalist fellowship, and states that we have more autonomy and feel more comfortable managing basic pediatric problems than many other programs, and he will actually lose autonomy when he goes to fellowship, and many residents apply for fellowship because they don't believe they can manage a service of their own yet.

 

[McPoyle]

Get over it. Suck it up, do your work, and move on. Christ...


Sent from my iPhone using SDN mobile app

 

[Perrotfish]

This has been discussed plenty of times, but I'll throw in my two cents anyway. Yes the system is crap. Yes residents are treated like slaves and the whole system should be overhauled. It's absurd.

That said, WITHIN THE CURRENT SYSTEM, trust me when I tell you that you're much better off with the 28 hour calls than you are with doing 14 or 16 hour shifts. I was limited to the 16's when I was an intern, and my ICU/ off-service months were hell. Come in at 6AM, leave at 7:30 or 8PM when night float takes over, and do that 6 days a week. Never a chance to spend time with family or go do anything. Just work, sleep, work, sleep, work, sleep, and try to catch up on necessities on your one day off. On the other hand, with the 28 hour calls, I worked like a dog and went home dog tired, but at least I got a couple of actual DAYS OFF during the week. And actually got to see my family and spend some time with them.

This is very individual. I can function for months at a time on night float with no worse than a moderate case of depression. I can't function at all after a 28 hour shift: I sleep, wake up for an hour to eat an entire pizza, go back to sleep, and wake up the next morning. I definitely don't see friends or family. I also can't really function during the last few hours of the 28 hour shift. I crashed my car into stationary objects after two of them, and my patient care at the end of that kind of shift was terrible. My health also deteriorated rapidly over my few months of true Q4 call. Generally I would average 10-15 pounds of weight gain in a single month. Night float FEELS terrible, but I could get into a routine that lets me keep up a healthy diet and even a bit of exercise. Q4 call is just too irregular for that. 'Call' and 'post-call' are both excuses for bad behavior, and that's 3/4 days on the rotation.

Worse than me were a few friends of mine who suffered from migraines. Even a very well controlled mild migraine disorder becomes absolutely uncontrolled when you don't sleep. I knew one resident who lost her residency over it: every call day, around the 20 hour mark, she would just start vomiting and wouldn't stop. There was no cure other than 'only' working 18 hours a day, which was not considered a reasonable accommodation, so they ****canned her.

 

[Astra]

Worse than me were a few friends of mine who suffered from migraines. Even a very well controlled mild migraine disorder becomes absolutely uncontrolled when you don't sleep. I knew one resident who lost her residency over it: every call day, around the 20 hour mark, she would just start vomiting and wouldn't stop. There was no cure other than 'only' working 18 hours a day, which was not considered a reasonable accommodation, so they ****canned her.

that is apalling.

 

[emergentmd]

This has been discussed plenty of times, but I'll throw in my two cents anyway. Yes the system is crap. Yes residents are treated like slaves and the whole system should be overhauled. It's absurd.

That said, WITHIN THE CURRENT SYSTEM, trust me when I tell you that you're much better off with the 28 hour calls than you are with doing 14 or 16 hour shifts. I was limited to the 16's when I was an intern, and my ICU/ off-service months were hell. Come in at 6AM, leave at 7:30 or 8PM when night float takes over, and do that 6 days a week. Never a chance to spend time with family or go do anything. Just work, sleep, work, sleep, work, sleep, and try to catch up on necessities on your one day off. On the other hand, with the 28 hour calls, I worked like a dog and went home dog tired, but at least I got a couple of actual DAYS OFF during the week. And actually got to see my family and spend some time with them.

geeez... I don't want to sound like an old Geezer but before 80 hr limits, I did 120 hrs in Surgical rotations with every 3rd day call. If I had 80 hrs in my days, no matter how it was stacked, it would have felt like a vacation.

 

[Perrotfish]

geeez... I don't want to sound like an old Geezer but before 80 hr limits, I did 120 hrs in Surgical rotations with every 3rd day call. If I had 80 hrs in my days, no matter how it was stacked, it would have felt like a vacation.

No one actually works 80 hours. The 80 hour week of shift work for me was about 90-100 in the hospital, and that didn't count admin work and studying which was usually another 5-10 hours/week. In many residencies that time in the hospital doesn't even count your charting, which Residents do at home, but thankfully the military computer system is far too much of a catastrophe for any of us to chart at home.

The issue is that you are scheduled for 13 hours a day from sign out to sign out, and you usually sign out in multiple locations: first sign out starts at 05:00 and last sign out starts at 17:30 and takes 30 minutes. But you don't go home after sign out if the work isn't done. And the work is never done. So you can't work less than 13 hours/day, 78 hours/week, even if by some chance you get a light week. On the other had you can stretch that 13 hour day to a 16-18 hour day pretty much every day, and then you spend your day off doing the presentation or admin task you've been assigned that week.

Once I had a NICU block where we only had simple patients, there was only one sign out at night, and we really did leave at sign out and rest on our day off. I only worked 75 hours/week that block. It did feel like a vacation.

 

[mvenus929]

This is very individual. I can function for months at a time on night float with no worse than a moderate case of depression. I can't function at all after a 28 hour shift: I sleep, wake up for an hour to eat an entire pizza, go back to sleep, and wake up the next morning. I definitely don't see friends or family. I also can't really function during the last few hours of the 28 hour shift. I crashed my car into stationary objects after two of them, and my patient care at the end of that kind of shift was terrible. My health also deteriorated rapidly over my few months of true Q4 call. Generally I would average 10-15 pounds of weight gain in a single month. Night float FEELS terrible, but I could get into a routine that lets me keep up a healthy diet and even a bit of exercise. Q4 call is just too irregular for that. 'Call' and 'post-call' are both excuses for bad behavior, and that's 3/4 days on the rotation.

There is an intermediate system--you do 12ish hour shifts during the week, and then take call on weekends. It allows more weekend time off, since you can get by with one less person working over the weekend, and you end up working roughly the same number of hours (you just shift one of your shifts to complete it all at once) anyway.

 

[Perrotfish]

There is an intermediate system--you do 12ish hour shifts during the week, and then take call on weekends. It allows more weekend time off, since you can get by with one less person working over the weekend, and you end up working roughly the same number of hours (you just shift one of your shifts to complete it all at once) anyway.

Our hospital insisted on full, well rested coverage on the weekend. Whoever had the day off was replaced by someone on a clinic block. Having worked in a hospital that did your system ours was definitely a lot safer our way, though also more exhausting for us since we never got golden weekends even on clinic blocks. I'm not sure I would change the way we did it, if I had the choice. I think I saw more errors with those half coverage weekend schedules that I did in the rest of residency combined. I was grateful I never actually caused one.

 

[2021Doctor]

You would never want your bus driver or airplane pilot working 28 hours in a row.
Somehow it is supposed to be okay to force a doctor to do it.
You would never advise a patient to work 28 hours in a row.
Where is the compassion of physicians for their colleagues?
The whole thing is absolutely sickening.

 

[neusu]

You would never want your bus driver or airplane pilot working 28 hours in a row.
Somehow it is supposed to be okay to force a doctor to do it.
You would never advise a patient to work 28 hours in a row.
Where is the compassion of physicians for their colleagues?
The whole thing is absolutely sickening.

Quite frankly, most of our mistakes made are silent. Even the ones that are not, mostly harm one person. A bus driver or airline pilot, on the other hand, can harm an order of magnitude or two more in one instance. Likewise, in theory, the doctors being forced to work 28 hours at a time have supervision of someone who knows what they are doing and is presumably more rested.