Opinions on the shorter resident work hours

QUOTE (MD/PhD slave @ Oct 17 2002, 10:46 AM)
If work hours are so important to residency program directors, why cant I volunteer to work a guaranteed 130 hour work week and finish in a half year shorter?
Surely I should have the option to do that since they think sleep doesnt matter and every hour spent outside the hospital is a waste.

Probably the same reason you can't work 40 hours per week and finish in 10+ years.... because they make the rules and they said so.

So, will residencies in general, and surgical residencies in particular, become longer as a result of the limits on hours? Who will decide how long - ACGME, the specialty boards, the residency programs themselves, etc?
I have heard that the length of a residency should not be a primary factor in one's choice of specialty. As an older med student, however, I do wish to spend the majority of the rest of my working career as a practicing physician or surgeon, and not as a resident. Any idea when such changes in residency years might be determined?

The NEJM has some articles on this topic this week.
http://content.nejm.org/cgi/content/short/347/16/1249
http://content.nejm.org/cgi/content/short/347/16/1296
http://content.nejm.org/cgi/content/short/347/16/1275
Cheers,
LM


cool.gif

Hey Laramisa,
The articles are password protected.

QUOTE (mrwagner @ Oct 21 2002, 08:54 PM)
So, will residencies in general, and surgical residencies in particular, become longer as a result of the limits on hours? Who will decide how long - ACGME, the specialty boards, the residency programs themselves, etc?
I have heard that the length of a residency should not be a primary factor in one's choice of specialty. As an older med student, however, I do wish to spend the majority of the rest of my working career as a practicing physician or surgeon, and not as a resident. Any idea when such changes in residency years might be determined?

Hi there,
The residency programs themselves will decide the length of the residency. My program director has specific requirements that the residency program must meet in order to be accredited by the RRC and ACGME. There are specific numbers of cases and specific numbers of procedures. At present, I log all of my procedures on a national website. The specifics and conditions of each procedure is logged also.
If my number of hours gets cut back, my numbers will be cut back and I might not make my minimum requirements under the present allotment of years with shorter hours. I would urge you to keep in mind that I am a surgical resident. My whole training venue revolves around my compentency with cases and procedures. My residency will have to lengthen in order for me to get the specific numbers of procedures completed for competency.
At age 50, I am not relishing being in a residency program longer than seven years but it UVA goes to eight or nine years, I am there without question. I made a commitment to become a safe and competent surgeon. To that end, I totally trust my residency director to provide program guidelines for me to accomplish this. He is fair and honest with what is expected of every resident. There are no shortcuts to proficiency in surgery.
Since I am in a program that has a bare minimum of scut, I shudder to think what other programs with far more scut are turning out even today with the 120 hour weeks.

Sorry about that- I’ll try to post them again in a different way to avoid the password. LM
SPECIAL ARTICLE
===============
Patient Safety: Fatigue among Clinicians and the Safety of Patients
D.M. Gaba and S.K. Howard
http://content.nejm.org/cgi/content/short/347/16/1249?query=TOC
==============
SOUNDING BOARD
==============
Duty Hours for Resident Physicians – Tough Choices for Teaching
Hospitals
D.F. Weinstein
http://content.nejm.org/cgi/content/short/347/16/1275?query=TOC
====================
HEALTH POLICY REPORT
====================
The Debate over Residents’ Work Hours
R. Steinbrook
http://content.nejm.org/cgi/content/short/347/16/1296?query=TOC

Okay, well, it didn’t work, but at least you have the titles! wink.gif but if you go to the AMSA site (www.amsa.org) and look at the health policy list serve it should be there, because that’s where I got it. When I opened the link through the email I got from the listserve, I didn’t need a password. (plus at my work I have the journal) It’s the Oct 17 NEJM.
I saved it as a PDF file at work so tomorrow I can try to paste that in if you’re interested. (if there’s not some copyright restriction)
LM

njbmd,
Thanks for your reply.
I took a look at the 2001/2002 GMED Companion, and I noticed that there seems to be quite a bit of variation in the average hours/week listed among the general surgery residencies. Many list averages at or below 80 and several are even significantly below 80 already. Of course, many are well above 80, 90, 100, …
So, I am starting to wonder, what factors could explain how these averages can vary so much when (if I understood your reply correctly) the accrediation requirements specify the number of cases and procedures, not hours. Several possibilities come to mind:
- sites may raise their program requirements above accred. requirements
- accred. requirements may differ from one site to another (e.g., to suit state mandates)
- the frequency of the requisite cases is higher at some sites, enabling the residents to complete requirements with fewer hours “on the clock”
- some site “fudge” on their reported avg. hrs/wk
- the number of years at each site varies (though I thought 5 yrs for gen. surg. was common, that is, without a research option)
- there is a fundamental flaw in my understanding of surgical residencies
Any thoughts on this?
Thanks,
MR

Hi there,
There are some places where residents do not report all of their hours. Some places do not report on-call hours as UVA does take on-call as part of the total. My residency director is deadly serious about getting us down to 80 hours but he wants those hours to be totally meaningful. He is not trying to cut corners. He simply wants to keep the quality of this residency very high. Our academics are protected time and we are not paged out of conference.
He wants us to account for every hour that our beeper is in use meaning that time off is just that i.e. off, meaning off-beeper and off-call. Beyond that, he is going to cover with NPs and PAs doing the scut work like dictating charts and discharges. Even now, we only have to cover the cases that have teaching value. We do not even attempt to cover every case that is done at UVa.
Most of my duties this year have consisted of caring for patients in the perioperative period but this all changes next year. There is ample focus on me getting huge numbers of junior resident-level cases. This year, my OR time has largely been because I am fairly efficient with floor work. If my floor duties and clinic duties are done, I am expected to be in the OR and I am usually found there. I pester the senior residents to call me for cases when I am on call. So far, I have a very impressive list of cases that I have been able to get valuable experience like my double lung transplant with VSD repair. It was sweet even though the patient was very sick.
Surgery is going to be a long residency because surgeons have to learn procedures. You won't be able to count on getting all of your cases unless you are pro-active. As the hours are cut back, the cases will be more difficult to acquire. Fortunatly, UVa is busy enough that we are not stepping over each other at the upper levels. There are only 4 residents above the PGY-2 level in any year. Still, you don't do a double lung transplant every day.
Nat