New intern work restrictions

[migirl]

One thing is not clear to me ... These new rules apply to interns only? Or is it all PGY?

Ok something I don't get is all the frustration for weekends gone. Um - we didn't have most weekends together in the first place. Maybe this is cause he is in EM, but weekends spent at home was a luxary in the first place. Third year was better, but still it was hit or miss. As a spouse, I would have rather a more functional home life for the exchange of an additional year. Yes, it's nice to be done now - in three years. But I can't count how many times I was left in the errie hell hole life of a single parent alone in a town away from family with no money for a sitter to help me out in those dire times of needed time alone. We couldn't afford to live close to the main hospital where he worked, as we had kids and one in school and couldn't afford a home in a good school district close by. So we lived 30 min or 45 w/traffic, away and when he was gone for 24+ hours I worried like hell that I would become a widow. Talk about stress. Again it's nice to be done, but I think Heidi is right. What does extra hours have to do with real learning? I think people are just nervous about changing. From what I understand places like the UK which already keep hours more reasonable do increase the years for training. No? Sure you can't have it all, so you need to increase time to make up for cases not seen, in the same breath the ortho resident wives I met who's husbands were at Duke sounded like they were truly living hell on earth. One ortho resident's wife was in labor, was in surgery, only observing, and was told he couldn't leave early but he could eventually have more kids. WTF?@@!!!! That resident had the balls to leave early anyway, but COME ON. My experience is that medicine is a machine and residents aren't treated like normal people. Life is NOT supposed to happen to them. What - a family membor died. Too bad, you need to work. A new baby, you'll meet him eventually. Nice. Give me an extra year for a more stress free life - thank you very much.

End of rant here>

Umm, probably too idealistic. Dh has seen residents walk out in the middle of a case because they were getting close to their hour limit, this was bad for the patient, bad for the other physicians, and bad for the resident in question because they lost out on a ton of learning. Dh has seen med students take a day off because they feel they are supposed to get a full 24 hours off after call. Unfortunately, this attitude is becoming more and more prevalent. Like Jenn, I am not saying 120 hour/week is where its at but the lack of training (and it is scary what newly minted attendings don't know anymore) is going to have to be addressed as it is a significant piece to this puzzle.

This boggles my mind.
My SO works closer to 120 hours a week right now then he will ever work 80 & he would never dream of just walking out because his hours were up.
He's an intern in a ridiculously unregulated program right now... I can't imagine this program is going to abide by these new regulations when they are so abusive to the ones that are already supposedly in place.

[scarlett09]

Ok something I don't get is all the frustration for weekends gone. Um - we didn't have most weekends together in the first place. Maybe this is cause he is in EM, but weekends spent at home was a luxary in the first place. Third year was better, but still it was hit or miss. As a spouse, I would have rather a more functional home life for the exchange of an additional year. Yes, it's nice to be done now - in three years.

I think my frustration (and Julia's) for the possibility of not having weekends off is specialty dependent, and even more specifically the residency programs our spouses are in. I know that my DH gets at least one golden weekend a month - there is no home call, no "can you come in and look at this/do surgery/etc" - and I look forward to these times. Right now, I am a graduate student, so I do get to spend additional time with DH when he is post call on weekdays or on the weird Q2ish NICU schedule. But this is all going to change when I go back to work in the summer and I will only get to spend weekends with him. And the amount of golden weekends will decrease in July as soon as I start a new job, which is pretty shitty timing. But if that is what we have to endure for only one year to be finished with residency forever, then I will do it. There will be grumbling, but I will power through it as I have the last 1.5 years.

And I absolutely agree with you that training should not be extended in order to make up for the loss of training time. I'm glad that we will be done in three years (maybe four if we add on a chief year) and that there are no fellowships on the horizon. I can't imagine what it would be like for those of you who had 5, 6, or 7 year residencies to stay on an extra year!

[SuzySunshine]

If they even think about extending I'm glad we're getting out now. No. Way. In. Hell.

[Pollyanna]

Amen!

[Flynn]

If they even think about extending I'm glad we're getting out now. No. Way. In. Hell.

I'm laughing with you Suzy but don't throw anything at me because if I were in your shoes (and I was ) I would feel the EXACT same way. MORE time? Um, No thank you!!!!

I've always thought (after listening to DH rant about it and doing my own research) that certain areas of medicine NEED more time -- training hours shortened or not.

If I had a dollar for every FP doc who "watched" something with a patient only to THEN call Cardiology two months later who calls my DH within a week to give "Joe Trainwreck Smith" to him we could run away somewhere warm and never come back. Medicine is SO screwed up right now from beginning to end IMO. If you attempt to "fix" one area you hurt another.

With all that being said, training SUCKS any way you slice it.

[SuzySunshine]

You know I love you Flynn!

If they're going to extend training they need to do it BEFORE the individual's residency starts - we signed up for 8 years, and if half way through that someone said you have to add a year or two I'm not sure what we would have done but you better believe we'd have had a good talk about it.

[diggitydot]

DH is in a pretty cush program, and even I'm amazed that some peeps have weekends. Totally gobsmacked.

[Thirteen]

My DH is FP, and I can assure you that he doesn't get "weekends." And when he's not working, he's moonlighting so we can move/pay for the boards/pay for another med license/have money on-hand for child-related expenses.
When I see him on the weekends, it's usually because he's post-call, or coming home from moonlighting.

[SuzySunshine]

Moonlighting now also counts toward the 80 hours so that will affect a lot of people too.

[Deebs]

For DH's program, moonlighting was always included in the work hour rules. When emergency physicians are in the department, their work hours are pretty tight anyway because there's not even an opportunity for "down time." They are limited to a 60 hour work week in the department, for patient care, and must have time off before the shift equal to the length of the shift (so if they're on 12 hour shift, they can't have 8 hours off before shift start). I don't think you can teach someone how to work through exhaustion. However, if a physician has never experienced his/her limits while under supervision, how will he/she do when they hit their limits on their own? Again, maybe this is specialty specific. When DH is on his 14th hour of a shift of a 30-40 patient night, he knows he is not doing certain procedures. He will call down a resident or another attending to do the lumbar puncture, ultrasound (so he doesn't miss something), etc. He learned those limits by being pushed to the limit, at times, during training.

And, I'm writing all of this after having to pick DH up from work because he literally fell asleep before starting the car this morning. He worked for 15 hours last night, couldn't even drive home, will have nine hours off, and goes back in for a 12 hour shift. I'm not saying all of medicine doesn't need massive changes, but I'm not sure these hour restrictions are going to improve patient safety.

[mommax3]

I don't think you can teach someone how to work through exhaustion.

I agree with this, and I am sure my take on this whole thing is specialty dependent, but I *do* think someone can be taught to go from sleep to surgery in 10 to 15 minutes. DH has to do this all the time as an attending, and he wouldn't be able to do it if he hadn't worked the hours he worked during residency. The docs he has had to bail out didn't have this type of experience during their programs, and there could have been tragic outcomes as a result. And, as I type this, DH worked a 13 hour day yesterday, was up with pages numerous times in the night, left before daylight, is still at the hospital, and is on call until 7 Monday morning. That is after working four 10 -14 hour days M - Th, and being on call M and W nights. This is NORMAL life. He has been an attending for almost 10 years.

[Bittersweet]

“Strategic napping, especially after 16 hours of
continuous duty and between the hours of 10:00 p.m. and 8:00
a.m., is strongly suggested.”

This part of the new regulations cracks me up. What's next, scheduled nap time.

DH’s program uses a traditional Q4 call schedule and each call shift is 30 hours. I don’t know how they’re going to manage the shift. I imagine, since interns may no longer work more than 16 continuous hours, that they’ll establish some sort of hybrid night float/short 24 hour call system. Either way, I don’t expect that DH will see a reduction in work hours. He’ll still average 80 hours/week. Except now, many of those hours will extend late into the evening when we normally (assuming it isn't a call night) actually get to see each other. We’d both far prefer that he get 60 of those 80 hours over and done with during two call shifts. Oh well, no one asked us.

[GrayMatterWife]

My DH is FP, and I can assure you that he doesn't get "weekends." And when he's not working, he's moonlighting so we can move/pay for the boards/pay for another med license/have money on-hand for child-related expenses.
When I see him on the weekends, it's usually because he's post-call, or coming home from moonlighting.

I've got a good friend who's in the same boat...married to a FP resident who works hours comparable to my DH's! Then I know GEN-Surg residents who I constantly see at the cafes outside the hospital, at long lunches. WTH???!!