Work Hours Waiver

[Ttan]

So Im a premed student, and I follow a few surgeons around every now and then and watch them conduct business. One of the surgeons I follow grills me on surgery residency work hours, and he keeps mentioning residency programs which offer waivers that give residents legal release on their work hour limit.

He says that some people in the new generations of surgeons exiting residency programs with the work hour limit are not competent surgeons and not fitted to move on from their residencies. He says that these surgeons are not getting the proper chance to follow their specific cases through the entire process of healing too often because they are obliged to follow the work week limit and leave.

Anyone of you have a take on this? Or information about these programs?

 

[Winged Scapula]

So Im a premed student, and I follow a few surgeons around every now and then and watch them conduct business. One of the surgeons I follow grills me on surgery residency work hours, and he keeps mentioning residency programs which offer waivers that give residents legal release on their work hour limit.

The work hours limits are not laws so there is not such thing as "legal release".

The ACGME/RRC does allow some programs an increase in the maximum to 88 hours per week, averaged over a 4 week period. There is no "waiver" for individuals nor any waiver for an average over 88 hrs per week.

He says that some people in the new generations of surgeons exiting residency programs with the work hour limit are not competent surgeons and not fitted to move on from their residencies. He says that these surgeons are not getting the proper chance to follow their specific cases through the entire process of healing too often because they are obliged to follow the work week limit and leave.

Anyone of you have a take on this? Or information about these programs?

Its hard to know what the truth is.

It is certainly true that surgical residents are working much fewer hours than they did in the old days. However, having done 120+ hour weeks, I can tell you that I was not always operating or doing clinically useful stuff during all of those hours. But I would be lying if I said that the reduced work hours didn't reduce some experience...there is something to be said for just "being there".

Hell, I've probably learned more just in the first few years in practice about wound healing and normal post-operative complications because of "being there". Some things you just aren't going to see in residency because of he nature of rotations.

Whether or not your surgeon is one of these guys who always thinks that the "kids" behind him have it easier than he did, or is right is an unknown. His reaction is common and many do fear that new surgeons just aren't as skilled. But this runs a lot deeper than work hours:

- more and more are choosing fellowships which narrows the field
- autonomy is a thing of the past in many surgical residencies; either due to litigation reasons or pressure from programs
- less operative time (ie, somethings we always used to operate on are now managed medically)

Finally, no one knows if the newer surgeons are less skilled than prior generations AND whether it makes a difference. Perhaps new grads are less skilled but become just as skilled as their partners a few years out.

 

[Substance]

I think work hour restrictions should be even more strict. It's not about how long a resident is in the hospital - it's about what they are doing while there.

Plenty of a resident's time is spent doing non-medical things that have no place in the repertoire of a physician's duties. Things such as social work have no place in residency training - that's what the social workers do, so we should let them do it.

Furthermore, when one has been awake for more than 24 hours, it is well known that they are as cognitively impaired as a drunk. Learning, and more importantly practicing safe medicine, is adversely affected.

I've seen a lot of residents who are learning by dogma and muscle memory - kind of like what nurses do - rather than learning overarching concepts. They do do do, but don't, or more accurately can't, think. If something comes up that is outside of their usual habits, they cannot handle it because they just didn't have the time to read and deduce concepts outside of the hospital. It is this reading, combined with the practice of medicine, that produces true medical competence. There has to be balance.

 

[CambieMD]

I think work hour restrictions should be even more strict. It's not about how long a resident is in the hospital - it's about what they are doing while there.

Plenty of a resident's time is spent doing non-medical things that have no place in the repertoire of a physician's duties. Things such as social work have no place in residency training - that's what the social workers do, so we should let them do it.

Furthermore, when one has been awake for more than 24 hours, it is well known that they are as cognitively impaired as a drunk. Learning, and more importantly practicing safe medicine, is adversely affected.

I've seen a lot of residents who are learning by dogma and muscle memory - kind of like what nurses do - rather than learning overarching concepts. They do do do, but don't, or more accurately can't, think. If something comes up that is outside of their usual habits, they cannot handle it because they just didn't have the time to read and deduce concepts outside of the hospital. It is this reading, combined with the practice of medicine, that produces true medical competence. There has to be balance.

Residencies should be lengthened to assure that trainees are adequately trained. I am tired hearing about life style and work hour reductions. A tired resident is dangerous but no less dangerous than the ,"hand-offs," that occur now.

Cambie