Residency Shift Restrictions

Saw this article in the Boston Globe today and thought some of you might find this interesting. (Text is pasted below since the link might not work after a day or two.)
http://www.boston.com/business/articles/2004/10/28/a_wake_up_call/
Brigham battles dangerous mistakes by limiting doctors’ hours
By Liz Kowalczyk, Globe Staff | October 28, 2004
Dr. David Andorsky, a resident at Brigham and Women’s Hospital, woke up from a two-hour nap in the on-call room at 6:30 a.m. last Tuesday. Andorsky had been on duty since 7 a.m. the previous day and still had a few hours to go caring for patients in the intensive care unit.
But because of the hospital’s ground-breaking research on medical errors, Andorsky, 29, was not allowed to order medications for patients during morning rounds.
Instead, that task went to Dr. Anne Liu, who was fresh from a full night’s sleep at home.
The hospital is placing new restrictions on how many hours doctors can work, the result of findings published by Brigham researchers in today’s New England Journal of Medicine. Researchers found that first-year residents, or interns, who worked 24 to 34 consecutive hours every three days committed 35 percent more serious medical errors than when they worked a maximum of 17 hours.
While working the longer shifts, interns made 136 serious errors for every 1,000 patient days, compared to 100 errors on the shorter shifts. Patient days are the combined number of days all patients spent in the ICU during the study period. On both shifts, the vast majority of errors involved medications. Usually interns prescribed the wrong dose.
Andorsky, who participated in the study, is now a third-year resident. “I feel awake right now,” he said Tuesday morning after his short rest. "I don’t see why I shouldn’t be able to enter a simple order. But that’s why we do these studies. Because everyone thinks they can do it. It’s easy to put in the wrong medication for a patient when you’ve been up all night."
To many people, the Brigham findings may sound supremely obvious. Anyone who’s stayed up all night knows how hard it is to stay alert the next day. But the medical profession has been slow to acknowledge the dangers of sleep deprivation, and scientific studies on the impact of long hours are rare.
This is partly because of how medical training evolved. Residents once lived at their hospitals and followed cases from beginning to end as part of their training. Getting to know patients and seeing them through their hospital stays still is considered an essential part of residents’ education.
Some older doctors also believe that the punishing hours weed out young medical school graduates who aren’t hardy enough for the profession’s demands. And even physicians who are open to change fear that shorter hours will hurt residents’ education, as well as increase “hand-off errors,” which occur during the confusion when a doctor arriving at work takes over patients for doctors going home.
But the Brigham is trying to take a hard look at medical errors, even if it means opening the institution to public scrutiny. “The hospital is very courageous in allowing us to put the institution under a microscope,” said Dr. Charles Czeisler, one of the authors and a nationally known sleep researcher.
The results have national implications, as the 100,000 residents now training in US teaching hospitals routinely work more than 24 hours straight. Errors could be even higher at other hospitals, as the Brigham has a sophisticated computer software system that in many cases stops doctors from ordering the wrong doses or drugs for patients.
In the study, senior residents, doctors, and nurses intercepted more than half of the interns’ errors before they reached patients, suggesting that a strong safety net exists in at least some hospitals. In one instance, an intern prepared to slide a needle into the left side of patient’s chest and draw out fluid. But a senior resident walked into the room, saw what was happening, and told the intern the fluid was on the right side.
But senior doctors did not catch all of the errors, including one in which an intern ordered an antibiotic for a patient – even though he had a known allergy to the drug. The patient received one dose before the mistake was discovered, but he did not have an allergic reaction.
Dr. Christopher Landrigan, one of the researchers and director of the hospital’s sleep and patient safety program, said all of the errors combined caused harm to a patient in the two ICUs every three days. But researchers defined harm very broadly, and in most cases, harm meant a patient had an allergic reaction, an irregular heart beat, or that treatment was delayed. No intern errors led to a patient’s death, he said.
In an editorial accompanying the Brigham studies, Dr. Jeffrey Drazen, editor of the New England Journal of Medicine, said the current system is flawed, but he raised concerns about shorter shifts. Drazen, who worked as an attending physician in the Brigham ICU during the study, said that the interns working shorter shifts were “more awake.” But he said they “often knew very little about patients admitted the night before they came on duty,” indicating that hospitals must find ways to provide residents with more complete information about patients’ histories as they move to shorter shifts. The study did not specifically record so-called hand-off errors.
While he praised the Brigham for opening the ICUs to public scrutiny, he pointed out the number of errors even when interns worked just 16 consecutive hours, saying that “the overall ICU performance in this trial was not exactly stellar.” Given this, he said, additional solutions are needed, such as more rigorous teamwork.
During the study, 24 interns in the hospital’s medical and cardiac intensive care units were studied during three weeks of a traditional schedule: from 7 a.m. the first day to 1 p.m. the following day, every three days. For another three weeks, interns worked a modified schedule: researchers added an extra intern to the rotation and divided the overnight shift between two interns. In the end interns on the modified schedule slept an extra six hours per week and worked about 60 hours total. They worked about 80 hours a week on the traditional schedule.
Interns who participated in the study from July 2002 to June 2003 allowed researchers to glue 10 electrodes to their heads for long stretches to measure their drowsiness. They wore the contraptions while talking to patients, watching movies, eating in restaurants, and sleeping. Portable monitors attached to the electrodes recorded more than twice as many instances of profound fatigue at night–measured by interns’ eyes rolling back in their heads–in first-year residents working the longer shifts.
Dr. Aaron Kesselheim, now a third-year resident, said the strangest part of participating in the study was seeing “The Matrix” on opening night with electrodes pasted to his skull.
“The data doesn’t surprise me,” he said. "It’s common sense if you’re awake 24 to 26 hours you’re going to be really tired. But people in medicine don’t like to change their practices without good hard data."
Kesselheim said he’s been so tired he’s fallen asleep on morning rounds, while standing up. Before the study began, Andorsky said, he once ordered the wrong antibiotic for a patient after being awake all night. But, he said, he realized the error and corrected it before sending the order to nurses.
Landrigan said that the study has limitations. Being done in one hospital, it was too small to really measure patient harm, since such adverse events are rare to begin with.
But Landrigan said it was a significant step and taught doctors several lessons.
In July 2003, the Accreditat

ion Council for Graduate Medical Education adopted new limits on resident work hours, restricting their average week to 80 hours on duty. But the new rules still allow residents to work up to 30 consecutive hours – which Landrigan said appears to be too much.
In the past several months, the Brigham began prohibiting all residents on duty 24 hours or longer from ordering medications, said chief medical officer Dr. Andy Whittemore.
And while most surgery shifts are now 12 hours because of the new ACGME rules, the hospital plans to reduce shifts for all residents to no more than 16 hours by next summer – a plan that will cost hundreds of thousands of dollars to hire additional staff.
“On the basis of four data right now, interns in high-intensity settings should not be working shifts longer than 16 hours, and really the number may be lower than that,” Landrigan said. “My sense is that five or so years from now, people are going to have to prove that working these extended shifts is actually worth it.”

Hi there,
All of this stuff sounds wonderful to many people who believe that it will make medicine more 9-5 but in reality no matter how restricted your hours as a resident, you have certain requirements for graduation. In my case, I have a minimum number of cases that I have to do in order to be eligible to become board certified. By cutting my hours drastically, my case load goes down. The 80-hour work week restriction has drastically cut my case load. The next step is to lengthen residency which means that with your “user friendly” hours, you spend a couple more years at slave wages. (Most chief residents make less than $45,000)
When you are done with residency, you will spend far more hours in the hospital as an attending physician than you did as a resident if you want to actually take home enough money to pay off your medical school loans and live indoors. Malpractice insurance premiums are in the six figures and you have to pay malpractice in order to open your door. After malpractice, you have to pay your office staff, pay your rent and then pay your self. If you are not working and billing, you are not going to make any money.
I fully expect to have many days as an attending vascular surgeon on call, where I start at 6am, do my cases into the afternoon, see patients in my office and round in the evening and do emergency cases. If you are in danger of losing your arm, do you really want the vascular surgeon to say that it is after 6pm and I have been up since 5am so I can’t do your surgery? Since most of my colleagues are working the same schedule, where are you going to get a replacement?
It’s not residency folks where you put in the hours, it going to be when you start billing for those hours. You can’t bill for work that you don’t do. If you want 9-5, go to business school or do something else.
Natalie

Well said. I had discussed this with a transplant surgeon we know and that was exactly his take. Well…not so much the pay but the fact that an 80 hour work week is a light week for an attending surgeon. So the new batch such as yourself and in 7 years me, will have to work harder after residency than during. With the precept of training harder than you’d ever plan to fight…in surgery it is now reversed. I have a vague understanding that residency is still no cake walk. However working less during residency will not give the future physician a true taste of what it will take. The resident will not develop the correct attitude nor discipline for the amount of work required to survive after residency is over.
It’s an ugly situation. Too much hours…a problem in the short term. Not enough hours…longer residency…more painful as an attending.

OK, fair enough–but the point of the study is that after a certain amount of hours folks start making more critical errors. If surgeons don’t start facing that increasingly well-studied and clearly demonstrated fact, they will be exposed to a whole new world of liability, and their malpractice premiums will rise further. The work hour issue isn’t primarily about what we want, although that’s an issue for our own safety if for no one else’s (for instance, residents getting in car crashes as they drive home); it should be primarily about what’s good for patients. The rest is secondary.





There are a lot of things you are making note of here, Nat, that could be changed if surgeons were serious about realizing that sleep deprivation isn’t good for patients. Including residency wages in the latter part of the process; the financial burden of training for surgeons generally; and how work is apportioned during the time you’re in residency (e.g., scut to procedures ratio just for one). I think that we need to start saying, OK, sleep deprivation is bad; now, how do we design the system? Rather than the approach you and most surgeons and many senior physicians are taking, which is: whether or not sleep deprivation is bad, the system is designed this way, so it doesn’t matter. That’s just crazy.





This idea that this is about medicine being 9 to 5 is also not the point. 80 hours a week is not 9 to 5.





As one letter writer noted in a previous debate on this topic, you could never do an ethical clinical trial of surgical outcomes with varying amounts of sleep–because it would be unethical to randomize patients to the sleep-deprived surgeon. Yet, we are doing that all the time in clinical practice, and for no better reasons than the financial and logistical reasons you list above. If there are sometimes good clinical reasons that a sleep-deprived surgeon must operate (she’s the only one who can do a particular emergency procedure, for instance), those financial and logistical reasons don’t even come close to meeting that level of justification. Surgery patients deserve better and everything should flow from that. Redesign student loans; redesign how surgeons are trained; but, please, don’t deliberately plan to operate on people at times when you are clearly more likely to make errors.





joe

Hey Joe,
The problem is that with todays reimbursements, you can’t make a living and pay your expenses if you limit your hours to 80. It makes no difference how much you WANT to cut your hours, you have to make enough to keep your office doors open.
You can work 40 hours in residency but you won’t be able to make any kind of living in surgery if you limit your hours to 40 as an attending unless you are a salaried professor. Even then, you have to bill for a minimum number of hours teaching, research and operating. It is the reality of the day. If you have loans, mortgage, office rent, Office equipment, office staff to pay, malpractice insurance and gas for the car, you don’t have much left over.
It didn’t take a study to realize that you make more mistakes with less sleep. Duh! What I have learned is how to manage my marathon days so that I am not doing fine detailed work at my 30th or 36th hour. Most of the time, I am rounding and assigning work. Not much danger to patients there but look out interns!
Natalie

Joe,
You are not living in the real world. there are many places, including urban areas, where there is a lack of general surgeons. They don’t want to get up in the middle of the night to perform life threating procedures, but have to because there is no one else available to do so. That includes urban and rural areas. Why anyone would choose general surgery is a mistory to me, but thank God some do.
If you haven’t been there, you have no place to judge.
Paul

I found this article interesting in that the resident was not allowed to give medications. Was he allowed to do procedures? If so, then what would be the point?

Quote:

Joe,
You are not living in the real world. there are many places, including urban areas, where there is a lack of general surgeons. They don’t want to get up in the middle of the night to perform life threating procedures, but have to because there is no one else available to do so. That includes urban and rural areas. Why anyone would choose general surgery is a mistory to me, but thank God some do.
If you haven’t been there, you have no place to judge.
Paul


Hi,
2 things: 1. my original post was written with in a post-early am rounding sleep-deprived state, so my sleep-deprived error was in posting it pre-nap rather than post-nap, hence the somewhat cranky tone (I think I need one of those post-call personas that Mary has);
and
2. my original post notes that sometimes there is a compelling reason for surgery with little sleep–for instance, emergencies. So, although it’s possible I was not living in the real world, that had more to do with my post-call near-psychosis than it does with my analysis of the demands of the surgical profession.
But this debate isn’t about emergencies. (And most surgeries are not emergencies–most are planned and scheduled.) It’s about how the healthcare system is designed. We have a shortage of surgeons in many places, and we have a reimbursement system that, as Nat says, rewards long work hours despite their dangers. Both of those things are correctable problems. We also have clearer and clearer evidence that sleep deprivation causes medical errors. And that is not likely to change and is not likely to be correctable.
Interestingly, some of the major reasons we don’t have enough people competing for surgery residency slots are issues of time and hours. If we just put on more hours on to the existing surgeons’ work load, this will be even more so–leading to a spiral in which surgery becomes a less and less acceptable specialty for new docs because there are fewer and fewer people doing it, which then makes it less acceptable, which means fewer people do it, and so on.
There are surgeons who are leading the way in workhour restrictions and error analysis and reduction; I hope that the field follows. If everything Nat says is true–and why wouldn’t it be?–I think that the solution to those problems involves finding ways of increasing the supply of surgeons, rather than stretching the field closer and closer to the breaking point.
best regards
joe

Though there are problems with Wisconsin’s risk pool system (in terms of raiding it to plug budget holes), it appears to be helping doctors enormously. Here’s a single article on it.

I have to say I agree with Joe. His post was “real world” in that he illustrated looking at the big picture.
The evidence exists that sleep deprivation = increased errors. Other professions have long been interested in this
topic ie airline pilots,nurses. It is positive that sleep
deprivation among trainees and medical professionals is being studied.
I find it very interesting that the buzz word now in medicine is “evidence based medicine”;yet, when the evidence exists, we make excuses.The top priority here should be patient safety not graduation requirements or financial considerations.
Of course, there are many pieces to the puzzle. However, just because something has always been so does not make it
right (residents work 80-120 hours per week). In fact, I would argue that if the evidence supports that decreased sleep = increased errors, then it is wrong to continue with the status quo. ? increased liability
This is a big picture issue that will require innovative big picture solutions. The million dollar question will be, will change occur? Change is difficult.
Shirl

If we lived in the perfect world, no patient would receive surgery from a sleep deprived surgeon. But we don’t live in such a world. there simply are not enough surgeons in everyplace at 24/7 hour availablitiy. don’t blame the surgeon( I’m an FP), blame the system. These surgeons don’t want to do surgery while sleep deprived, They HAVE TO. There is no one else available to do so. I for one pity them and their plight. They are hard working, dedicated individuals. And to imply that they have a choice to operate under a sleep deprived condition, indicates you have no knowledge or experience in the medical profession

There is nothing wrong with considering other options to the current system, for example, shifts. Why should one person be on call for 36 hours straight if two people could each work 18 hours?
And I know what you’ll say…there aren’t that many surgeons/OBs/whatevers…but if the system were more flexible, then perhaps more people would choose to go into the high-demand specialties.
Cut Joe some slack. We’re not here to rake each other over the coals.

The catch-22 is that if there were more surgeons then there would be room for flexibility. As to the current climate: there aren’t enough surgeons, period. It’s all a matter of lifestyle, IMO. Why the current trend in emergency medicine? Speak with someone long enough and the cost vs rewards of working in EMED come up. Lots of money for few hours. I’m not inferring that ER docs don’t work, they work fewer hours. When they are there they work but once the shifts over…
Surgeons are on call 24/7. I don’t want to change the direction of this thread, ie surgery vs everything else. My point is that there is a shortage of surgeons and while making the residency less painful it doesn’t prepare for the real world nor does it address the sleep deprived mistakes that happen.
I see both sides. My wife had the misfortune of having been operated by a sleep deprived surgeon. Yet I want to be a surgeon but know full and well the reality of being sleep deprived. I hate the “that’s the way it is” attitude but who is going to make a change of it? Who is going to defend the “rich, golfing, Benz driving, arrogant…” surgeon? The average Joe could care less about how a surgeon has to work 120 hours a week to make any real money. Average Joe has to send his wife to work and possibly get another job to make ends meet so the least the doctor can do is spend more time with Average during his visit. Also Doc, make sure to be well rested…
I just don’t see it being enough of a problem. See the patient makes some money and the lawyers make a boatload as do the insurance companies. Everyone wins except for the patient and doctor. Heck, there are doctors in California making up a “blacklist” of patients who have sued their doctors. I wish, really wish we had an answer. Perhaps looking at countries with good healthcare…Canada? See what we could do. I’d be willing to pay extra for stuff if that meant everyone received healthcare.
We all realize this is so much more complicated than merely correcting the hours worked. The things intertwined are so interdependent that one highly affects the others. This is the one major reason current docs have commented very strongly on “counting the cost”.

Quote:

I hate the “that’s the way it is” attitude but who is going to make a change of it? Who is going to defend the “rich, golfing, Benz driving, arrogant…” surgeon? The average Joe could care less about how a surgeon has to work 120 hours a week to make any real money. Average Joe has to send his wife to work and possibly get another job to make ends meet so the least the doctor can do is spend more time with Average during his visit.



Hi there,
None and I repeat NONE, of my attending surgeons drive a Mercedes or hang out at the country clubs. I drive a Toyota Corolla and will continue to drive this car until it falls into the ground. I attended medical school on a full-ride tuition scholarship with all of my graduate and undergraduate education paid for by scholarship so I have little in education loans to pay back. My malpractice premiums will eat up most of my starting income and I will be working many hours to pay my other expenses in order to practice the specialty that I love and that I am very good at.
The point here is that while I feel badly that you had a poor experience but the numbers show that the vast majority of people have surgeries every day with good to excellent outcomes. Bashing the surgeon who is working to make a living is not going to change the fact that sometimes things do not go as expected and it has very little to do with how much sleep a surgeon has had the night before.
Cutting hours during residency is not going to fix this problem or solve the problems that exist for most any specialty that in operation today. Reimbursements are down, malpractice premiums are up. When you finish suing your physician and suing the hospital where you physician has privledges, your lawyer is going to have most of your award and you are going to be stuck in the same place only this time you are frustrated because you are out of money and less likely to receive the medical care that you demand because the specialist that you are looking for is not there and attempting to perpetuate a stereotype that isn’t really applicable to today’s graduate surgical residency is not actually helpful.
Natalie

Nat,
Your preaching to the choir. That is why my benz comment was in quotes. I know the situation. The piece of crap who operated on my wife was not some sleep deprived surgeon but one whose skills deteriorated for lack of cases.

Quote:

If we lived in the perfect world, no patient would receive surgery from a sleep deprived surgeon. But we don’t live in such a world. there simply are not enough surgeons in everyplace at 24/7 hour availablitiy. don’t blame the surgeon( I’m an FP), blame the system. These surgeons don’t want to do surgery while sleep deprived, They HAVE TO. There is no one else available to do so. I for one pity them and their plight. They are hard working, dedicated individuals. And to imply that they have a choice to operate under a sleep deprived condition, indicates you have no knowledge or experience in the medical profession


Hi, I wrote a really huffy response to your last sentence–which I think shows you haven’t spent much time thinking about where I’m coming from or what I’m trying to say–and then I decided to look up your past posts. I see that you’re an FP doc in a small town in Texas. Hi. I’m glad you’re participating in OPM. As for me, I’m a medical student in Boston. And I can see how in DeLeon TX the surgeon who’s there is going to have to get up at night to do a surgery. Frankly that isn’t what I was talking about. That’s an emergency. It has to be done. I understand that. Although: we need a better system for medicine in this country, one which includes good access to care in all parts of the country. So, yes, I do blame the system, and not the surgeon. (And: if a surgeon in DeLeon or anywhere like it is taking a sleep-depriving number of scheduled patients to make more money instead of sending some of those patients to scheduled surgeries in cities a couple of hours away, that’s some combination of the system and a choice that surgeon is making, both of which I think we can criticize.)
But in Boston where there are surgeons all over town in relatively abundant supply, this is really another kind of issue. Prestigious hospitals like the Brigham and Women’s have made interns and residents work long hours just because they could, and not because they have to. And that’s what the study that started this whole thread–a study which was done at the Brigham and Women’s–is all about. So, just as I shouldn’t assume that our corner of the healthcare system here represents the reality that you face in yours, I don’t think you should assume that your lengthy experience of your corner of the healthcare system gives you an always-superior understanding of the reality we face in ours. I’m still building my knowledge and experience in the profession, but I can say with confidence that Harvard-affiliated hospitals like Brigham and Women’s have the ability to restrict hours to stop sleep deprivation, and I think those who resist that restriction in this context–and especially after a study like this one, even if it is a “no duh” finding–are not doing so with patient interests foremost in mind.
Best regards
Joe

Quote:

But in Boston where there are surgeons all over town in relatively abundant supply, this is really another kind of issue. Prestigious hospitals like the Brigham and Women’s have made interns and residents work long hours just because they could, and not because they have to. And that’s what the study that started this whole thread–a study which was done at the Brigham and Women’s–is all about. So, just as I shouldn’t assume that our corner of the healthcare system here represents the reality that you face in yours, I don’t think you should assume that your lengthy experience of your corner of the healthcare system gives you an always-superior understanding of the reality we face in ours. I’m still building my knowledge and experience in the profession, but I can say with confidence that Harvard-affiliated hospitals like Brigham and Women’s have the ability to restrict hours to stop sleep deprivation, and I think those who resist that restriction in this context–and especially after a study like this one, even if it is a “no duh” finding–are not doing so with patient interests foremost in mind.
Best regards
Joe


Hi there,
Do not forget that interns and residents are very cheap labor (no cost to the hospital). Hospitals can use interns and residents of offset the costs of other personnel and do so at will. Again, while your hours are limited to 80 averaged over a four-week period, those 80 hours are chocked full of work with virtually no downtime. You are expected to get the all of the work done that you had before and you are expected to get out of the hospital and home to STUDY because you have less hours. Medicare pays the hospitals somewhere in the neighborhood of $100,000 a year for each resident to cover the costs of your education. Make no mistake, you are very, very cheap labor with an advanced degree and hospitals will take the most advantage of this fact. Things come down to the bottom line (cost) long before patient care is a consideration. Most of the burden landed squarely on the housestaff who are responsible for both policing hours and attempting to provide a high level of care.
Natalie

Ugh–this thread! There are reasons malpractice insurance is so expensive in the United States. How about reforming the legal system a little? It’s the American way to sue, because we resist regulating the vast majority of our industries. How is health care any different? Insurance premiums are just one more component of a system that COULD, if people wanted, be changed. However, when I read some of these posts I feel like someone has just dropped a Vatican encyclical on my head. “This is the way it is and must always be, because that’s tradition and there’s no way to change. Anyone who suggests change is disloyal. Plus there are too many pressures on us.” I recognize that there are pressures on surgeons and other doctors, but I think surgeons are smart enough to start envisioning some new scenarios, rather than forever perpetuating the one and only system they’ve ever known.
Personally I’d be very hesitant to send a family member to a teaching hospital for surgery. I’ve pulled enough all-nighters in my life to know that my grandmother will be at risk if the person operating on her has been up for 30 hours. Anyway, if it’s ok for surgeons to operate while tired, then I think pilots should be allowed to fly planes when they’re tired, perhaps after staying up for say, 30 hours. Doctors should be the first to fly on those planes. And if we are required to take residents’ WORD (or the collective word of those in the surgery establishment) that they’re alert even though they’ve been up that long, then we should also take people on their word when they SAY they’re sober enough to drive but their blood alcohol level is above the legal driving limit. If residency programs are above outside scrutiny or regulation, then other professions deserve to have similar freedoms.
It just seems reasonable that if a hospital like Brigham CAN cut down resident hours, and it’s been SHOWN that the long hours increase errors, then the explanation for not reducing the hours is that there must be some benefit to the current system that hospitals like this are not beng candid about. And when has anyone ever voluntarily turned down cheap labor in favor of more expensive labor OR acknowledged to the world that cheap labor was their motive?
I do not have all the answers and am only a lowly premed, but it is frustrating to see such a chorus of support for what is clearly a less than ideal system, involving labor and legal issues where there is ample opportunity for reform.

Quote:

Quote:

Reimbursements are down, malpractice premiums are up. When you finish suing your physician and suing the hospital where you physician has privledges, your lawyer is going to have most of your award and you are going to be stuck in the same place only this time you are frustrated because you are out of money and less likely to receive the medical care that you demand because the specialist that you are looking for is not there and attempting to perpetuate a stereotype that isn’t really applicable to today’s graduate surgical residency is not actually helpful.


Hi, Natalie et al,
What happens to physicians who don’t carry malpractice insurance? I have read that this is becoming more commonplace. What’s the point in suing someone who has nothing but a car and a house and would declare bankruptcy to keep you from getting those? I would imagine that the average malpractice lawyer is going to be reluctant to take a case on contingency under such circumstances.
I wonder how much of the whole malpractice problem is caused by the insurance industry, which wants every doctor and clinic and hospital to be scared into paying this protection money because of a few high profile cases. Probably a few million dollars paid out to lawyers is a reasonable investment from these companies’ point of view.
Malpractice insurance–just say no!!!

Quote:

Ugh–this thread! Personally I’d be very hesitant to send a family member to a teaching hospital for surgery.


I recently had surgery at a teaching hospital, having had the SAME surgery a few years ago at a community hospital. Let me just say that I’ll NEVER,EVER, EVER again have another non-emergency surgery at another teaching hospital.