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?
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.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?
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.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.
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.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?
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.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
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
..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. .
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)?
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
?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??
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.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?
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 MedOriginally 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