Will general surgery residents really work only 80 hours per week?

[SomeFakeName]

Do you guys think that general surgery residents will really work only 80 hours per week maximum when the new rules kick in July 2003? Or will residency programs find ways to bypass the 80 hour rule and have surgery residents working more hours?

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[womansurg]

Our program is taking the mandates very seriously. We are probably a little unusual, in that we have been in compliance with the 'one day off in seven average' mandate all along, however. (So, I have had every other weekend completely off throughout my training - SWEET!)

The big trouble we are having is figuring out compliance to the 'maximum of 30 hours worked, with at least 10 hours off before resumption of duty' mandate.

How in the heck can you go home after 24 to 30 hours of call (essentially, leaving before noon) every third or fourth day, and expect to learn any surgery?

A better solution for surgery residents (which I have submitted to ACGME) would be mandatory protected sleep time during call - 4 hours for instance - during which you are required to hand off your pager to your in-house colleague.

That way you could stay through to the end of your post call days, not missing in OR or (god forbid!) clinic time.

 

[droliver]

We've taken it pretty seriously too in order to work out some of the kinks before JULY 2003. I completely agree with womansurg, it is really hard to learn surgery on a schedule that effectively removes 20-30% of you elective operating time if your post-call days are during the work week. Our chaiman & vice-chair (both past presidents of the RRC & Amer. Board of surgery) think an unintened consequence of the rules will be mass closings of many of the smaller training programs as it becomes financially untenable to maintain compliance

 

[SomeFakeName]

Dr Oliver, can you explain further why there may be closure of smaller programs due to inability to maintain compliance with the new work hour rule?

I would think that with the less hours residents can work, smaller programs would need more surgical residents to cover the workload?

 

[womansurg]

Originally posted by SomeFakeName
I would think that with the less hours residents can work, smaller programs would need more surgical residents to cover the workload?

Yep, exactly. The hospital has to pay for those residents (with some help from the US govt). I think I saw a recent quote that the estimated cost of surgical resident training is 120K per year (salary, health insurance, malpractice...). The hospital's compensation has to do with the extreme productivity of the resident - you can get alot of work done in 120 hours/week! If they have to hire more residents to do the same amount of work...some programs might not be able to cut it. Becomes cheaper to hire more ancillary staff - physician' assistants, nurse practioners, so forth.

 

[SomeFakeName]

Thanks womansurg...would smaller hospital surgical programs be able to stay open by hiring more ancilliary staff to cover for the decreased hours worked by residents instead of shutting down entirely?

 

[droliver]

SFN,

it's exactly these costs of hiring ancillary personal to pick up the slack that will be the poison pill for many community based programs. You can't just throw more residents into the mix because 1) a certain volume of procedures per resident must be maintained for accredidation in the face of 20-30% fewer operating days & 2) the feds would have to come up with the money (no guarentee). Take Yale's surgery program for instance..... I understand they recently "bought" back their accredidation by committing up to $10 million over the next ten years to fund (among other things) ancillary AHP's to do some of the work. Smaller private programs (hell even the larger ones & smaller university ones) will never be able to afford many of the costs that will be neccessary to comply with the new mandates as they currently stand. In addition with just a few residents as exist at some of the programs, the continuity will be so disruptive that it will be more trouble than its worth. A similar contraction took place during the early 1970's (there are many fewer programs today) for different reasons.

 

[jhug]

as one who may enter a surgery residency within the next few years-- how can i avoid a residency that may be closing down programs? i would sure hate to start a residency and then find out that some of the O.R.s i planned to work in are no longer available.

 

[womansurg]

Ask programs what status they were granted in their last evaluation by the Residency Review Commission (RRC), and whether they have ever been placed on probation.

That will not, by any means, correlate 100% or maybe even strongly, but it is a red flag that the leadership of the program may be faltering. Generally, compliance with ACGME mandates just ain't that blasted hard, and the RRC wants programs to succeed, so if a program is flaunting their noncompliance so much that official action has resulted, then there is probably a lack of attention to the details of running the program.

The regulations of being a surgery program director include that this should be your fulltime pursuit - not just an aside while you practice surgery. (Our program director is a retired vascular surgeon.) It's hard to imagine how a program could get so very far off track if an attentive, concerned program director is at the helm.

Look for evidence of cohesiveness. If everyone is miserable and overworked, there's probably not a lot of effort going into keeping the program functional.

Even if your program doesn't shut down during your tenure, it's a long five years you're putting in. Choose wisely.

-ws

 

[SomeFakeName]

How about surgical residents at large, university-based hospitals...will they work a maximum of 80 hours as mandated by the new rules, or will these residency programs find ways to make them work more hours? I've heard that there are some loopholes in the 80 hour rule that can be potentially exploited by residency programs to make the residents work more hours and not be in violation.

 

[southerndoc]

SFN, I've heard that programs may be granted a 10% extension in the work hour rule on a program-by-program basis. So some programs may be allowed to work residents 88 hours per week.

I have a feeling that many programs will extend their training time to 6 or 7 years in order to graduate residents with enough cases. This, coupled with q3 call, should do wonders for attracting new surgical candidates.

 

[womansurg]

I think you can expect to work around 90 hours/week on a regular basis. But this is still a dramatic improvement. Remember, I worked an average of 110-120 hours a week as an intern. That extra 20 to 30 hours per week is the killer. A 90 hour week is really quite livable.

 

[SomeFakeName]

Geek Medic, you bring up an excellent point about the possible negative implications on med student interest in pursuing G.S. if residency programs have to tack on a couple of extra years to the length of the residency in order to make sure the residents get enough cases...I suppose this is another unforseen consequence of the work hour limitations. However, you could also see this as causing a "lesser of two evils" scenario...would you rather train for 5 years at 90-120 per week or for 7 years at 80-90 hours per week? I suppose an extra 20-30 hours per week away from the hospital adds up significantly over those extra 2 years, and may be beneficial in the long run (i.e. on your mental and emotional health, time with family and outside interests, more time to read, etc).

 

[womansurg]

We always say that one of the advantages of our program is that, at the end of five years, you're still married. Stats back this up - divorce rates are astronomical in surgery training. Most of our residents are married and are parents, with most of the kids being born during the five years.

It's the construct of the training that dictates whether you'll receive adequate OR exposure - not the length of training or the number of hours per week.

When interns at some big Us are not even being allowed into the OR, our interns are doing lap choles and lap appys by their second month of training. Everything is relatively accelerated. I did abdominal aortic aneurysmsms, cystgastrostomies, pneumonectomies as a second year. We often pass the kidney transplants down to the interns here - we've done enough by the time we end our second year.

Just make sure you look closely at the program. Talk to the residents. They good programs are out there - you just gotta find 'em.

 

[Pilot Doc]

I (4th year med student) attended the ACS conference in San Francisco, and sat in on the Assn. of Program Directors meeting where they discussed the new regulations at length.

general themes from the meeting:

Case load: Two NY programs (Buffalo and Cooperstown) presented their experience with the Bell Commission. Both have made significant changes, but have maintained an appropriate case load. The driving force has been to contract the residency around the caseload. They have hired a lot of ancillary staff to do floor work, and pulled people from services with low operative opportunity for the residents.

There is the possibility of an 88 hour work week. The RRC has applied for a blanket surgical exemption, but for now it?s 80 hours/wk

The limit, be it 80 or 88, is real and will be enforced. It was repeatedly said that programs not in compliance would be shut down. It was also said that q3 in-house call was a near mathematical impossibility, even if technically allowed.

The only serious mention made about changing the length of training was to shorten it for fellowship-bound residents. (eg 4+2 for vascular, peds, etc.)

 

[southerndoc]

SFN, 7 years v. 5 years on a resident salary will be the big disadvantage. I would rather work a 120 hour week and get done in 5 years than 90 hours per week for 7 years. Most loan forbearance programs will not extend for 7 years. So the last 2 years of a 7 year program the resident would be making less than $50,000 per year v. $150-300,000 per year in private practice.

Womansurg, where are you? Your program sounds like a great program!

I guess whether students choose surgery or not depends on how well they want it. I am seriously considering surgery, and I don't mind q3 call nor 120 hour work weeks. Part of the fun is the road getting there. You see a lot of cool stuff during your residency! Most programs I'm looking at are q3 call for only 3 years and then it's q5.

I'm very interested to see just how programs change because of the residency reform issues.

 

[neilc]

i am a bit confused...as far as i can see the math doesn't support the theory that ancillary help can be hired cheaper than a resident surgeon. if you consider that a resident will make between 30-50k per year at 80 hrs a week, then ancillary help at 40 hrs a week plus time and a half for another 40 hours you are looking at between 12-20 k salary. i don't know many health profs that work that cheap! if you hired 2 ancillary staff per resident, you are looking at 15-25k salaries. that is low, guys. i think nurse aides may be that cheap, but not much else. besides that, there is a nursing shortage now...PA's and NP's have been mentioned, but i can't imagine getting them in very cheap. and they won't want to work the hours that a resident must work. and that doesn't even consider the government reimbursement for residents, and the fact that residents can do much more than any other help that you may bring in. even if residents are limited to 80 hours a week, i think that is still about the cheapest labor you can get, especially considering the scope of a resident's practice and the willingness (or not so willingness ) to work all hours of the day...

the only thing i can think that may offset this is some stipulation that the hospitals with residents must take care of a certain number of patients that cannot pay. get rid of the residents, get rid of that big finacial liability...

am i missing something?

 

[womansurg]

I'm at Iowa Methodist Medical Center, in Des Moines.
We're mighty proud *chokes back tear* of our little program here.

Part of why ancillary personnel are a better deal than residents: I probably spend 80% of my time in the OR - learning, or in conferences, etc. Only about 20% is spent actually doing work which someone else would have to do if I weren't there (eg H&Ps discharge summaries, etc). A PA would never see the inside of an OR - they'd be doing nuthin' but scut, baby.

Actually, this paradigm is in place and fairly common already. For instance, the orthopedic dept at my hospital doesn't have resident support (we do one 1 month rotation, during which we golf alot...) So all the docs have their own personal PAs, who do all their dictations, post-ops, follow ups, so forth.

Same thing in the ER - no ER residents, only rotating IMs and FPs for support, so they have several PAs working fulltime.

 

[dr.evil]

The regulations of being a surgery program director include that this should be your fulltime pursuit - not just an aside while you practice surgery. (Our program director is a retired vascular surgeon.) It's hard to imagine how a program could get so very far off track if an attentive, concerned program director is at the helm.

Actually, there are no such regulations as to how involved a program director can be in his/her own practice. This sucks bad when you have a program director who is so busy in his clinical practice that his secretary (if your lucky) will help you out when you need it. Sometimes the residents are on the back burner.

To all those who 4th years applying for any type of residency: Look at the program director and base a larger portion of your opinion of the program on that individual.

 

[njbmd]

Hi Folks,
I am in a fantastic residency program that is seven years long outside the 80-hour work rule. My program director is excellent and is taking the 80-hour work rule very seriously. I am certain that limiting resident work hours to 80 per week is going to add more years to my training. Surgery is a long residency and will probably get longer.

Some of the alternatives that my residency director is looking into for the upcoming year is hiring mid-level practictioners to do most of the scut work leaving residents more time to do surgical cases. Still, there are times when doing a long case such as a lung or liver transplant, that you are going to chew up hours. My last double lung transplant ran in the 12 hour range because the patient had a VSD that needed to be repaired too. I would not have traded the opportunity to do this surgery for anything on earth so I would want to have to scrub out because I am over the hours limit.

While I do not think that surgery or any other residents need to be worked into the ground to "build character", I think that the good programs will come up with ways to keep our education and training at a high level. I just think that those methods are going to add length to the residency programs. This is something to keep in mind as you are sending out your applications. I can say with total honest, that I would still choose this program (University of Virginia) even if the residency length goes to eight or nine years.

 

[MSTP boy]

I think that top tier programs could begin lengthening their training periods within a few yrs. If it does happen, there would be a 1-2 yr time period when much fewer surgeons would be getting boarded, think of the demand this would create..

 

[Celiac Plexus]

Originally posted by neilc
i am a bit confused...as far as i can see the math doesn't support the theory that ancillary help can be hired cheaper than a resident surgeon. if you consider that a resident will make between 30-50k per year at 80 hrs a week, then ancillary help at 40 hrs a week plus time and a half for another 40 hours you are looking at between 12-20 k salary. i don't know many health profs that work that cheap! if you hired 2 ancillary staff per resident, you are looking at 15-25k salaries. that is low, guys. i think nurse aides may be that cheap, but not much else. besides that, there is a nursing shortage now...PA's and NP's have been mentioned, but i can't imagine getting them in very cheap. and they won't want to work the hours that a resident must work. and that doesn't even consider the government reimbursement for residents, and the fact that residents can do much more than any other help that you may bring in. even if residents are limited to 80 hours a week, i think that is still about the cheapest labor you can get, especially considering the scope of a resident's practice and the willingness (or not so willingness ) to work all hours of the day...

the only thing i can think that may offset this is some stipulation that the hospitals with residents must take care of a certain number of patients that cannot pay. get rid of the residents, get rid of that big finacial liability...

am i missing something?

Yeah. Reducing work hours of residents is not being done to save money. It's being done because studies have shown that residents make more mistakes the longer they are awake. Reducing the resident work week to 80 hours will theoretically improve patient care by reducing mistakes by residents.

The problem that is created is that there is still the same amount of work and surgery that needs to be done. Hiring PAs, and nurses will cost a lot of money. But many programs want to maintain OR time for residents and reduce scut instead of the other way around so they are looking at PAs, RNs, whoever to come in and help with the scut. I have never heard anyone say that hiring PAs, and RNs is a cost-saving device. It is a response to the 80 hour work week.

It's going to put a lot of programs under financial stress. They are going to have to come up with the money to improve ancillary services. The other 2 options are to add more residents, or lenghten the training (which at some programs is a minimum of 7 years).

 

[pedisurg]

I also just returned from the ACOS meeting in San Francisco, and sat in many discussions regarding the future of general surgery residency.

Dr. L.D. Britt gave us an excellent presentation on HOW the 80-88 (80 hours +/- 10%) work week can work, they are currently inplementing it in his program at Eastern Virginia. The highlights includ eliminating a lot of the needless sitting around time, obsurd pre-rounding hours (no more 4:00 am pre-rounds), everyone comes in at 6:30am regardless, and rounds are done TOGETHER as a team. No more waiting around for afternoon rounds to begin....round between cases, and transfer some duties to the oncoming team. It IS doable, although programs and residents are going to work hard on getting on the same page....especially the older residents who are used to coming in so early and staying so late.....


I HIGHLY doubt that small community programs will go under...that issue was brought up at a cocktail party by some of the residency program co-ordinators, and it is not going to happen.

WE ARE going to catch a bunch of flack from attendings/older surgeons, etc....i.e. "when I was in residency..." and "what do you mean you have to go home, we have a great colecystectomy posted for later this evening!"

Another interesting topic that came up was the accelerated surgery training program, I think its called ASP or ESP or something like that....it entails beginning fellowship training AFTER 4 years of general surgery, instead of doing a chief year in GS. THIS WILL happen as well, and during the next 5 years we will see this happen. Lots of buzz about this as well, make sure to ask chairman about this topic during your interviews!

Love to post more, but have a trauma coming in!! ETA 8 minutes

 

[Yasergale]

This is a little off topic:

wouldn't asking the program director about the "accelerated program" or the 80 hr work week make me sound like a slacker?

I know I can ask:
"So how does the 80 hr limitation affect your residency program?"

But is there any other ways of determining how the program is going to handle this limitation?

 

[tripod]

I don't think it'll make you sound like a slacker. I fully intend on asking all program directors how their program is reacting to the 80hr work week rules if it is not addressed by them initially. Many programs are undergoing radical revampment because of those rules and I want to make sure that I am not matching into a program in turmoil or a program where I may have to stay extra years because I won't be getting enough cases.

 

[jargon124]

If the length of training goes up because of the regulatory measures you can count on a huge decrease in medical student interest in GS residencies. A seven year GS residency is rediculous, plain and simple. What if you wanted to do a fellowship? Add on another couple years? So we're up to nine years now? That's just not acceptable.

If I was going into GS I'd much rather work 100-120 hrs/week for 5 years add on precious years. I can only speak for myself, but I know that many others feel this way too.

The 4+2 accelerated residency+fellowship program sounds really interesting though...would that mean that you could apply for GS residency at the same time as a fellowship? Anyone have more info on this?

Also, I'm wondering if any other fields will have to look at lengthening their residency training periods. It seems like fields like neurosurgery would have to tack on years as well...?

This whole situation seems real messy to me...

 

[womansurg]

Originally posted by jargon124
If the length of training goes up because of the regulatory measures you can count on a huge decrease in medical student interest in GS residencies

For what it's worth, our program director has been highly interested and involved in formulation and implementation of ACGME mandates from the beginning; for instance, we've been in compliance with the one-day-off-in-seven for years now. He is giving no consideration (zero) to the prospect of lengthening training - for the exact reasons that you cite: people would be even further deterred from going into surgery, which is something that is already a problem.

There are lots of solutions, most of which involve cutting back on the scut work which residents have traditionally performed, rather than on the OR time or educational opportunities.

Our graduating numbers are huge despite the relative ease of our work hours. It's do-able; they'll find a way.

I would predict that programs considering lengthening training will have to reconsider when they consistently fail to fill in the match.

 

[Skylizard]

I'm going to be long winded:

Can surgery residency be 80 hours a week? I think so. Will it be an 80 or 88 hour week? I don't think it will be anytime soon in numerous programs.

People keep talking about the RRC rules etc... However, the 80 hour guidelines or recommendations have been around long before this year. The RRC is waving its sword alot more but I don't think it will change things much. The bottom line is that programs and residents publish/provide the information they choose to provide. I will give you an example, a program in Pennsylvania was recently visited by the RRC. They were clearly in violation of the work hours matter. They did not get put on probation because the residents didn't want to speak up to this issue. The reasons for the silence are numerous. Just to name a few: 1. the site visitor met with all the resident representatives together (PGY1-5). The interns didn't want to look like whiners in front of the seniors. 2. The seniors definately do not want their program to loose accreditation. 3. The mid-level that spoke out (a little bit) was subsequently blamed for potential probation (which to everyone's surprise didn't really occur). How many of you interns want to pick up the workload slack next year as a PGY2 if your program doesn't match? Think about that as you smile to the interviewees and tell them how your program is great, meets the 80 hour rule and of course the ever famous "we operate alot as interns".

Let's take another issue. How many of you have checked AMA Frieda database online recently? I have. I am surprised that almost every program in surgery is claiming 80-88hr/week with q3-4 call. Some programs even claim a 55-75hour week!!! That takes balls to make that claim. Yet this is some of the info that the programs publish online under the "AMA" name.

Can surgery residency be done in 80 hour weeks? Yes. Many hospitals have thriving surgery practices without residents. The problem is that the teaching programs have come to depend on residents for attending physician lifestyle and ancillary services. It's true the entire salary of a resident is not federally reimbursed. But, something that needs to be taken into account should be the unpayed "over-time hours" of residents and the services residents provide enabling hospitals to function without highering more nurses (i.e. yes, residents are sometimes replacing PA's & nurses). In addition, many hospitals/doctors will bill for resident procedures while the attending is eating turkey at home (i.e. a-lines, central lines etc...)...this is of course illegal. However, the point is that teaching institutes are not loosing money they are just managing it badly in my opinion and the old guard really enjoys the perks of having residents in the house.

sorry it was long.

 

[Skylizard]

I would further say that if some of the claims of 2 weekends completely off per month are true and the claims by programs that they are really meeting the 80 hour requirement just proves you can do surgery training in under 88 hours a week!!! I think it can be done it is just a matter of what sacrifices programs (attendings) are willing to make.

 

[dkwyler94]

I have read this thread and many of the other surgery lifestyle related threads with some interests. I am currently an MSII, so I have some time before applying to residencies. I am seriously considering surgery now, but also recognize this could change.

One of the major turn-offs I see with surgery is the lifestyle. I anticipate I will be married during the residency, and find it very difficult to consider working 100-120 hours/ week while staying married.

Some of my questions I have about the hours/week have been addressed in this post. Some questions I still have is:

Do you think the claim on residency hours on Freida is completely inacurate (it states 79.4 hours/week, q3 call, with 1 day off/week as average).

Also, doing the math I cannot see how 100-120 hours/week work. This would come to 14-17 hours/day 7 days a week. What is the average schedule like for a resident now?

Also, in regards to the 80 hour week and the concerns of how hospitals will handle the loss of income, how do hospitals without residents do it? I worked at a 280 bed hospital for 5 years before medical school. We had no resident programs. The hospital was for profit, and doing very well financially. If the government covers much of the residents salary, how do these programs not make ends meet?

Thank you.

 

[droliver]

dkwyler,

I'm not sure exactly what kind of facility you were working at per se, but it likely is a very different patient population than the indigent, trauma, complex general surgery, & tertiary surgical patient base that clusters @ teaching hospitals. The level of complexity & manpower needs to take care of these groups of patients are not feasible in most non-teaching hospitals. With rare exception, most urban teaching hospitals run very high deficits due to indigent care and I imagine the funding $$$ from the feds is swallowed up in the complex overhead system of running these kinds of health delivery systems.


The avg. work hours gets up as high as it does b/c of the ~2-3 nights a week in the hospital on call with a Q3 schedule as has frequently existed. I would imagine that 80-90 hrs/week is pretty average with a few services more & some less. This is all in flux due to the ACGME rules starting July 2003. You'll prob. see fewer rotations @ the higher end any more & fewer elective rotations away from core surgical rotations in order to redistribute manpower

 

[dr.evil]

The AMA/Freida website quotes hours per week WITHOUT call calculated in. That is how they claim an average of 79 hours/week.

I have just finished a brutal week in which I was physically in the hospital for 142 hours, 3 nights of call, 5 hours of sleep total in the hospital and 20 hours of sleep outside of the hospital. This is why we're going to 80 hrs/week next year. Some services can be downright painful. AND this is a "community" program. Luckily we do get 2 weekends of per month which gives me time to read SDN and sleep.

Anecdotal, I know.

This biggest concern with many programs if how Trauma will be covered. Right now, many programs are 24 on/24 off. This does not comply with the "no greater than q3 call" I don't think. I'm not sure if this is considered call or not. Anyone know? Some programs are talking about 12 on/ 12 off. It complies with no call and greater than 10 hours off after a shift. How do other programs handle Trauma with 80 hrs/week?

 

[Skylizard]

Originally posted by dkwyler94
..One of the major turn-offs I see with surgery is the lifestyle. I anticipate I will be married during the residency, and find it very difficult to consider working 100-120 hours/ week while staying married. .

Surgery is hard. The divorce rate has been high in residency in general. It takes a good partnership. Buy her a dog! Your partner can leave you during surgery residency or later when your miserable practicing a field that bores you (?radiology, ?derm, ?ER, etc...).

Originally posted by dkwyler94
?Do you think the claim on residency hours on Freida is completely inacurate (it states 79.4 hours/week, q3 call, with 1 day off/week as average)?

Some places it's true...maybe? I guess it's interesting to see every body talking about how their program is implementing steps to come in line with the guidelines but if you read AMA Frieda everyone is already inline. So, it makes you go hmmmm.

Originally posted by dkwyler94
?Also, doing the math I cannot see how 100-120 hours/week work. This would come to 14-17 hours/day 7 days a week. What is the average schedule like for a resident now??

Well, calculate it with this in mind: 1. in house call starts (depending on program and service) anywhere from 04:30-06:00 am. You generally do not go home post-call until about 17:00 the following day. Now calculate that throwing in an occasional Q2 with the Q3.

Originally posted by dkwyler94
?how do hospitals without residents do it??We had no resident programs. The hospital was for profit, and doing very well financially?

First, reimbursement varies from state to state and county to county. Patient population varies also. One example, Kim can back me on this one, Penn State's trauma actually made profits and bought scanners for the hospital because they got so much reimbursement from the automobile insurance companies for MVA's. If you are the elite facility with the latest greatest then everyone dumps on you and since your the last stop you are stuck with all comers. Having said that, I still believe there are a great many physician administrators that should not be in the administration business.

I hope this helps.

 

[Winged Scapula]

Originally posted by Skylizard
One example, Kim can back me on this one, Penn State's trauma actually made profits and bought scanners for the hospital because they got so much reimbursement from the automobile insurance companies for MVA's. If you are the elite facility with the latest greatest then everyone dumps on you and since your the last stop you are stuck with all comers

Quote " We [Penn State Hershey Med] NEVER close to Trauma (referring to other institutions going on bypass for Trauma, ED, Medicine admits, etc.)" - Director of Trauma, PSU Hershey Med

Quote "You call, we haul " - PSU Hershey Med Ped Surg resident handbook, referring to the fact that we take ALL Pediatric Surgery transfers

So...we DO get "dumps" - a LOT of them. Some are legit - ie, we have in-house Neuro, Ortho, ENT, Ped Surg, etc. that a lot of the smaller outside facilities or area community hospitals don' t have. Then again, we often get Trauma transfers which could seemingly be taken care of by ANY doctor/surgeon but somehow arrive here on a trumped up call.

That's fine - we know we can take good care of these patients, and yes, the Trauma program does make a profit. Not only because of Trauma, but because several of the Trauma surgeons also do gastric bypasses which are pure money-makers for the program. It recently bought us a portable U/S machine for use in the Trauma bay and a few years ago, a dedicated Trauma CT scanner.

Most of our Trauma is blunt, MVAs/MCCs usually. These patients tend to have insurance, at least auto if not health. This is in contrast to the local community hospital which gets most of the penetrating trauma - many of whom have no insurance; but they make their money elsewhere.

As for the hours, others have explained it pretty clearly IMHO. The FREIDA database generally doesn't include call hours and has been notoriously wrong (on many fronts, not just hours worked) for ages. I frankly believe very little except perhaps the PDs name on each program's page. It is not hard to do 130+ hours per week if you come in at 430 am each day, don't leave until 730-8 pm and especially if you do a q2 call and don't go home post-call until maybe 530 or 600 pm (as was my schedule for a couple weeks last year on CT Surgery). Even now, with the changes, I was coming in at 4:30 - 500 am (and the interns even earlier) on my Trauma rotation and not leaving generally until 7 or 8 pm, with a couple of earlier days (ie, 6:00 pm). Call is now around q5 for us.

The lifestyle does break up a lot of marriages, but it doesn't necessarily need to if both of you have a common goal - to get you through residency with your marriage and sanity intact. Your SO must have a life outside of yours to survive your residency because he/she will spend a great deal of time without you - so unless you are attracted to the hermit type who doesn't mind being alone, they will have to make an effort to amuse themselves those long hours (even if "only" 80 per week) while you are away.

 

[Skylizard]

I still highly recommend a DOG!!!

 

[dkwyler94]

Thank you for your comments. While I still have time to consider what I will do, as I said surgery is creaping higher up on my list. Everything I am considering (ENT, OBGYN, Surgery), has surgery involved.

I'll keep this things in mind. And maybe get a dog. I've always like labs.

David

 

[handygirl]

Those applying to general surgical residencies and those who are already in the early stages of their residencies should be wary of a solution to manpower issues which is already being used by my program director--the lab year(s). My director has hired more residents than he is allowed to graduate in order to staff the mid-level years and is trying to stash people in the lab for as long as is convenient to him. Thus, if you're not careful, your indentured servitude could be extended one, two, or three years longer than you anticipated. Even worse, our lab years are slowly evolving into "float" positions for the services rather than protected lab time--we take a fair amount of call to fill in the gaps, and a plan is emerging to have us cover evening and late-night cases. Get the amount of lab time you will be required to do in writing and make sure it is protected.