Would you be in favor of extending residency if the hours were better?

[ArrogantSurgeon]

A couple of the general surgical trainess I know in European countries work a lot less hours (about 45-55 hours per week) than residents in the U.S. However, on average they are in training for 2-3 years more than U.S. residents.

Would people be in favor of extending general surgery residency for a few years if that meant they'd only work a maximum of about 45-55 hours per week throughout residency?

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[maxheadroom]

No.

 

[apma77]

NO..but theyll make an exception for you arrogant im sure

 

[jollygood]

Originally posted by ArrogantSurgeon
A couple of the general surgical trainess I know in European countries work a lot less hours (about 45-55 hours per week) than residents in the U.S. However, on average they are in training for 2-3 years more than U.S. residents.

Would people be in favor of extending general surgery residency for a few years if that meant they'd only work a maximum of about 45-55 hours per week throughout residency?

Arrogant being extraordinarily ridiculous again. Why pose such a question when working 45-55 hrs/wk is not even an option? It was hard enough to get them to go to 80 hrs/wk and the battle has just begun.

 

[ArrogantSurgeon]

Originally posted by jollygood
Arrogant being extraordinarily ridiculous again. Why pose such a question when working 45-55 hrs/wk is not even an option? It was hard enough to get them to go to 80 hrs/wk and the battle has just begun.

This is not at all a far-fetched option. Surgical residents in many other countries work far less than 80 hours per week, however the total number of years they are in training is extended. This is one way in which we could decrease the number of hours residents work per week. It would certainly make training more enjoyable and less stressful on family life if we could work only a maximum of 45-55 hours per week.

Although the currently revamped 80 hour rule may seem like a blessing, it is still a lot of hours for people who want to have live a life outside of residency and have plenty of time for their family. I mean 80 hours per week is like holding down 2 full-time jobs and only getting paid $35-40,000 a year total.

 

[doc05]

this proposition is so stupid it's not even funny. One reason that they work fewer hours in England is that their healthcare system is so f--d up that noone is adequately cared for, fewer operations are done, and care is in general very unaggressive.

How many attendings work 45-50 hrs per week, in any specialty? Derm and ophtho notwithstanding, most practicing docs do about 60 hours/week, so why should we expect less from residents?

and given that you'd get far less experience in a much shorter workweek, they would need to extend a surgical residency to about 9 or 10 years. That would discourage many more potential surgical residents than any 80- or even 100-hour work-week.

 

[njbmd]

Originally posted by ArrogantSurgeon
A couple of the general surgical trainess I know in European countries work a lot less hours (about 45-55 hours per week) than residents in the U.S. However, on average they are in training for 2-3 years more than U.S. residents.

Would people be in favor of extending general surgery residency for a few years if that meant they'd only work a maximum of about 45-55 hours per week throughout residency?

Hi there,
My residency program is already 7 years. I would not want to see this program go to nine or ten years. Even with the 80-hour work week (averaged over 4 weeks) my learning was swatted. Patients do not get sick 9 to 5 and therefore surgery is never going to be 9 to 5. None of my attending physicians work 80 hours per week. They are more like 100 to 120 hours per week. If you want 9 to 5, pick something else.

njbmd,
Non-arrogant but very cool Surgeon

 

[apma77]

you should change your name from arrogant to foolish for asking this question..i cant believe your a resident and you would say this $@#@*&(*&#@

 

[makatak]

Well, I disagree. Their health care system (the wealthier european countries) is actually very good. Their rates of medical errors, ratio of nurses/doctors to patients is better than ours nationwide. The ACGME has recognized this discrepancy. We had a grand rounds about this issue, and it was amazing how much less "red-tape" was involved in pt care in europe.

The difference in most european nations is that you go straight to a medical track from high school. Not many of their physicians do four years of liberal arts before applying to medical school. So they get an early start anyway. I did an away rotation in switzerland and their intern class consisted of 21-23 year olds. And they were VERY good.

I think 80 hours is great for surgery, if it is 80 hours education, not service. I feel like I would work >80 hours if it is OR and patient care.

I think extending the years will turn away more people, despite having to work less hours.

If you think these questions are stupid, don't answer. I see stupid questions and i just refrain... This is something the ACGME had actually considered.. 50-60 hour regulation as apposed to 80, with increased number of years.

 

[ArrogantSurgeon]

Again, no need for hostile replies. As I have previously stated, and now also has makatak, is if you do not like a certain question then you are under no obligation to reply to it with hostility and juvenile name calling. Simple ignore it and move on.

Now getting back to the topic, I have found most residents in Europe to be just as good, if not better, to what we produce in America, despite the fact that we work so many more hours. This may be due to the fact that so many of those longer hours here in America are wasted doing scutwork and other duties that don't have any real learning value...when they can instead be used to read and learn on your own.

njmbmd, you say that your residency is 7 years long. Is that 7 years of all clinical training or is it 5 years clinical + 2 years of required research? What I was implying is that the clinical experience could be extended so that we could work less hours per week.

 

[Winged Scapula]

There is a difference between offering a proposal and asking for opinions. I was not aware that Arrogant Surgeon was offering a proposal to change the US residency system to more closely resemble those of our European brethren (which we all know would be a MAJOR undertaking, not likely to happen any time soon) but rather was simply asking an innocent question.

Cool your jets folks...

 

[makatak]

Well, one thing's for sure. Our system may not be the best in some respects, but it's surely not the worst. In many south american countries (Columbia, Venezuela) you have to PAY for residency. You do not get paid, and you work long hours.

I think our struggle now is to find a balance, and i think we are headed in the right direction.

 

[ArrogantSurgeon]

Originally posted by Kimberli Cox
There is a difference between offering a proposal and asking for opinions. I was not aware that Arrogant Surgeon was offering a proposal to change the US residency system to more closely resemble those of our European brethren (which we all know would be a MAJOR undertaking, not likely to happen any time soon) but rather was simply asking an innocent question.

Cool your jets folks...

Going on a European tangent here...

Although the training is more benign in most European and Commonwealth countries, the requirements to be finally "board certified" in those countries seems to be significantly more arduous than what we have here.

Here if you get into a categorical surgical residency program, then you are basically guarenteed to finish and become board certified (neglecting any major problems along the way). However, in the UK for example, to become a Fellow of the Royal College of Surgeons (FRCS; like our board certification by the ABS), you have to pass the MRCS exam, which is known to have a first-time pass rate hovering around 20-30%. Compare this to our ABS exam which, according to an attending at my med school, has around a 85-90% pass rate for first-time takers. Not only that, but even if surgeons in the UK eventually pass the MRCS after a few tries, there is no guarantee that they can advance in their training and subspecialize...they may have to wait around for a few years until a position opens up in their desired training program.

So there is a trade off: Here you work a lot harder, but are more secure in knowing you will become board certified in the specialty you want. Over there you have a more benign schedule, but your are not as secure in knowing you'll be board certified in a timely manner (e.g. it may take a few more years compared to America to finish training and become certified).

 

[womansurg]

Originally posted by Kimberli Cox
Cool your jets folks...

Yes...please.

We need to conduct ourselves with a little more professionalism and a little more fellowship. AS is acting as a naive junior member of our community - nothing more. He doesn't deserve the type of derision and contempt that he's encountering here. It's especially ironic since some of the perpetrators are folks who are so vocal about eliminating the abusive surgeon stereotype.

We don't have to agree by any means, but for god's sake, let's not eat our own young here.

 

[Skylizard]

Originally posted by ArrogantSurgeon
...Although the training is more benign in most European and Commonwealth countries, the requirements to be finally "board certified" in those countries seems to be significantly more arduous than what we have here.

Here if you get into a categorical surgical residency program, then you are basically guarenteed to finish and become board certified (neglecting any major problems along the way)...

At the risk of being flogged in public for pointing out a REAL error in your thesis, I will reply. It is absolutely wrong to say "you are basically guarenteed to finish and become board certified". This is just not true. First, look at the programs around the country. Even taking into account the slight of hand tricks used by PD, the national average completion rate is NOT 100%. If for no other reason, UofChicago clearly effects this average. Second, the first pass board rate is NOT 100%. In some programs the pass rate is under 80%*. Finally, I will finish with a few examples. During my surgical internship, the PD and Program coordinator were very frustrated at a recnt graduate. He had matched in one of the most competitive CT surgical fellowships and had just FAILED his written portion of the boards. Obviously, this reflects badly on the Gsurge residency program and is a red mark in their "first pass" board rate column. I will give you another example that DrKC can actually vouch. A certain Vascular Surgery atttending at a University program had actually failed the Gsurge boards a sufficient enough times that if she failed her next attempt she would be required to take further Gsurgery residency training before trying again! It bares repeating; it is absolutely wrong to say "you are basically guarenteed to finish and become board certified".

AMA Frieda numbers (take with caution as Frieda can be innaccurate and is based on voluntary information)
University of California (San Francisco)/Fresno Program 80.0%program completion rate
University of California (Irvine) Program 95%program completion rate
University of California (Davis) Health System Program 98.0%program completion rate
University of Connecticut Program 90%program completion rate
Brigham and Women's Hospital Program 95%program completion rate
University of Massachusetts Program 90%program completion rate
University of Michigan Program 98%program completion rate
Henry Ford Hospital Program 90%program completion rate

These are clearly big name programs. Clearly the majority of programs do not share the same degree of prestige. I do NOT know what the rates are in the community programs and lesser prestigous University programs. Clearly the information is out there and you just need to look for it.

*clearly the exception and remark based on numbers two years old.

 

[Skylizard]

Originally posted by ArrogantSurgeon
A couple of the general surgical trainess I know in European countries work a lot less hours (about 45-55 hours per week) than residents in the U.S. However, on average they are in training for 2-3 years more than U.S. residents...

*So, I am talking with a "Brit" surgeon. He tells me that anywhere up to 20% of UK surgeons achieving new "consultant" status are suspended for inadequate performance. He also told me the 2nd & 3rd year surgery residents averaged around 50 cases/year. These cases included emergency things like appys and were not predominantly major/large cases.

I guess if this data is correct...you just got to love those 55 hour weeks


*clearly third+ hand information that I can not confirm. I actually have not been able to find any good data on the number of cases or % of post-graduate suspensions. I doubt this is data anyone really wants to publish over there.