I know that ACGME has imposed a limit of 80 hours/week, averaged over a 4-week period, upon accredited residency programs. I have heard that some institutions have asked for the restrictions to be loosened from 80 to 88 hours, citing a lack of resident-hours to properly staff the hospital (frequently general surgery programs). How prevalent is this? Which specialities/programs have asked for it? Is this relaxing of hour limits an erosion of the original 80-hour limit, leading eventually back to the 120+ hour resident work week?
The increase in resident hours was not for staffing purposes but for continuity of rotations (Transplant surgery and Trauma surgery) where you are likely to have longer cases.
Resident staffing in a hospital has very little to do with getting permission to rotate a resident 88 hours instead of 80 hours. At Virginia, only the Trauma chiefs and Transplant chiefs can do the 88-hour week. Everyone else is well under 80 hours and the department chair is adament about residents staying under hours.
Residents are not part of hospital staffing and are not used as such except in instances where some residents (anesthesia for example) are allowed to moonlight.
Since residency programs must petition to allow some (limited number) residents to go to 88 hours and must provide plenty of evidence that the resident’s educational experience would suffer by leaving after 80 hours, most programs have not been approved to go to the 88-hour work week.
If a program is malignant and using residents for slave labor (work quickly gets around), those programs quickly go down in quality. When I was interviewing for residency, I could pick out a malignant program in a second and I didn’t rank any.
There are plenty of things about residency that can kill you quickly besides the hours. I would rather spend 88 or even 120 hours in a great program than 40 in a dump.
Thanks njbmd. How did you know if a place was malignant or not?
Anyone else have experience with residency hour limits? Does the limit account for paperwork, or is that expected to be done on the resident’s time?
- RxnMan Said:
Anyone else have experience with residency hour limits? Does the limit account for paperwork, or is that expected to be done on the resident's time?
I was able to sniff out the bad programs by looking at things on my interview day including my fellow interviewees and the way that the residency program is run. I was not wrong. I also interviewed at only two programs that I would never rank.
I was fortunate to have rotated through Mayo Clinic as a fourth-year medical student. I know what a good surgery program looks like, feels like etc.
You are not permitted by RRC rules to be in the hospital more than 80 hours per week (averaged over 4 weeks) period. You have to be efficient and get all of your work done. For most residencies (IM, FM, Psych, Peds etc.) this is not a problem. For surgery, it can be a problem unless your program made arrangements to maximize your learning and minimize the non-educational aspects of your work.
It is useful to learn to do the paperwork but LEARN is the operative word here. PAs and NPs can do dictations. In the case of surgery, anything that takes away from your operative time is non-educational. Good programs realized this and hired some mid-levels.
I have seen programs where the PAs would take sentinal cases from residents. Believe me, that would never happen at Virginia (excellent surgical residency).
There are some programs that will not allow residents to cover the patients of physicians who do not teach or those who are not good teachers. (How this is handled is something that you need to ask during your residency interviews).
Having residents cover your patients is not automatic. You have to earn that right by good teaching. Residents are not "slave labor" for hospitals either. Good programs and program directors will not allow this to happen. If the RRC gets wind of resident abuse, they will shut down your program. Check out the Yale General Surgery program and Internal Medicine at Hopkins. Both went on probation and could have been closed because they ignored the rules.
Having your resideny closed is sad but being abused is worse.Fortunately, most residency programs want to produce safe and competent physicians as opposed to abusing their residents. Word of mouth can quickly tank a malignant program too and long before the RRC can act.
As an anesthesia resident, the workhours restrictions did not have the same effect on us as it does other disciplines. This largely due to the nature of being an anesthesiologist vs other physician types. We do not have clinics, pt rounds or other continuity of care issues. Anesthesia is largely a ‘fly solo’ sorta gig. Turning over pt care involves a lot less papershuffling & more 1-on-1 interaction about the nature of the pt, the surgery & how they’ve responded to interventions.
Therefore, virtually all of our clinical time occur within the OR & in active pt management. So, we are typically working on pts for the entire 70~80 hours per week.
Another characteristic of anesthesia is that your days tend to be shorter, less taxing & with more reading time as a CA-1 vs CA-2 or CA-3. As you progress through your training, our cases become monumentally more complex, challenging & the pts much more “ill” at baseline. Therefore, our days tend to be longer & harder fought. The trade off tends to be that seniors tend to do less call. Our CA-1 class forms the ‘jr resident’ call pool & the CA-2s & CA-3s compose the ‘sr resident’ call pool - spreading our call b/t 16 residents instead of the 8 in the junior crew. Of course, since a 2:1 call ratio would be a bit unfair, the sr pool occasionally finds itself doubled up on call - makes for a great night - to preclude turning the juniors into slave labor.