New intern work restrictions

[Pollyanna]

How are your programs handling the new 16 hour work limit? Dh is not sure how his department is going to make this work, and not only make it work on paper but make sure the interns are not losing out on valuable training (which they most certainly will). I do know that the new OB residents will have quite a surprise when they get to attendinghood and discover that they will be expected to work twice as hard as they did in residency.

Here is a link provided by Scarlett09:
http://acgme-2010standards.org/approved-standards.html

Yes, I'm living on the edge. I figure if Kris posted a mothering debate yesterday I might as well lead us into the weekend with this

[DCJenn]

At some point they're either going to have to accept the fact that graduating residents won't be as well trained OR that residency is going to have to be extended. You can't have it both ways. As it is the current attendings think that the 80 hour restrictions limit exposure to things which leaves the resident less prepared for real world scenarios.

I'm not recommending a return to the 120 hour work week, because that sucked for everyone but I do think that they're going to have to extend training. The first time someone dies because a new attending had never seen _____ before and that comes out at the M & M? Especially if it's a training institution?

I'm sure I've now pissed off every single medical student spouse. Oh well. It's just my opinion and opinions are like assholes, as they say!

Jenn

[MissCrabette]

I don't feel strongly either way. That said...

The new hours do sound short to me. However, maybe I'm naive to think that residents would be motivated enough to read as much as they can and to discuss interesting cases even if they're not the ones managing the patient. I don't think the hours would be to blame if someone dies because an attending had never seen X condition while in training. It would be the lack of reading and involvement in their own education. But I guess some people will clock in and clock out, and let the learning stop there. *shrug*

[Meenah]

I agree with you Jenn. A few months ago we had a new Pediatric Atttending in the ER who admitted she couldn't do a particular procedure because she had never done it before, only read about it! You have to have exposure to procedures to learn them. Just reading it in a book doesn't cut it.

[MissCrabette]

Good point, Luanne. Does anyone know why they reduced the hours so much?

[mommax3]

I agree with both Pollyanna and Jenn. DH isn't really the hard core surgeon-type personality, and he doesn't work at a teaching hospital (nor does he want to), but he already thought the 80 hr week regulations watered down the training residents received. I read him the posts about the intern work hour restrictions last night (neither of us had heard about them yet) and he just shook his head. The real world will be a shock to these new docs! I have posted before about the group of four Ob/Gyns that were in a University affilliated (and supported) practice at DH's hospital.....they had prime office space, right across from L&D, and all of the prestige of the University's name and marketing, and they went under. None of them were willing to work! All had trained under the 80 hr. system. DH and his partner (2 people) almost always had more deliveries per month than this group (4 people) and always had more surgical cases. They complained if they had been at work more than 50 hours that week, each took one weekday off per week, and never volunteered to serve in any departmental capacity. DH twice talked them (two different docs) through difficult delivery scenarios after being called by the nurses because the docs were freaking out with no idea what to do. THAT is what hours in the trenches gets you. I can't believe IU would have "given" this plum practice opportunity to mediocre residency grads....I am pretty sure these were cream-of-the-crop residents with an experience deficit and no concept of how much and how hard they would need to work to make it financially.

[scrub-jay]

I'm sure I've now pissed off every single medical student spouse. Oh well. It's just my opinion and opinions are like assholes, as they say!

Not pissed at you. It is the medical training dilemma.

[Meenah]

Christina, we cross posted, but how appropriate!!!!

[Mrs. MD, Esq.]

I think the restrictions will certainly make things more difficult in terms of seeing what residents want and need to see. That being said, there are some loopholes in the new regs where there are good reasons to stay longer (educational reasons, complicated case needing continuity of care or considering the patient's and the patient's family's needs). For the most part, i expect residents (who have worked hard to get where they are) will want to see and experience everything they can. Granted, I am basing that off my fiancé who goes out of his way to get as much exposure as he can...i doubt that will changed much next year for him.

Maybe I am too idealistic though...

[corn poffi]

My BF is pissed about these new restrictions. He really doesn't think that he's going to see enough cases his intern year, which means a much bigger caseload the following years. My guess is he'll be trying to find the loopholes to work longer and see more cases.

[poky]

Good point, Luanne. Does anyone know why they reduced the hours so much?

Because sleep deprivation causes lapses that kill people? Because sloppy handoffs because the outgoing resident is beyond exhausted kill people? Because once you're exhausted, you're not actually LEARNING anything any more anyway? Sorry, I know you probably already know that, and that may not even be what you were asking.

I'm all for making it take another year or two, if that's what's needed in exchange for reasonable hours. That said, it's entirely possible 80 hours *if it's actually enforced and adhered to* is "reasonable hours".

I think a lot of our perspectives here are at least partly specialty-specific. DH is probably going into EM, and I'm reasonably comfortable saying most EM attendings don't work 80+ hours a week, so there's no 'real world' shock waiting for him because some hospital isn't making him work 120 hours a week during residency.

[Pollyanna]

For the most part, i expect residents (who have worked hard to get where they are) will want to see and experience everything they can. Granted, I am basing that off my fiancé who goes out of his way to get as much exposure as he can...i doubt that will changed much next year for him.

Maybe I am too idealistic though...

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.

[Pollyanna]

Because sleep deprivation causes lapses that kill people? Because sloppy handoffs because the outgoing resident is beyond exhausted kill people? Because once you're exhausted, you're not actually LEARNING anything any more anyway? Sorry, I know you probably already know that, and that may not even be what you were asking.
.

True, but I would argue that lack of training will, in the end, kill more people than sleep deprivation. Of course there will never be any data on that.

[madeintaiwan]

I agree with you Jenn. A few months ago we had a new Pediatric Atttending in the ER who admitted she couldn't do a particular procedure because she had never done it before, only read about it! You have to have exposure to procedures to learn them. Just reading it in a book doesn't cut it.

DH's institution has been interviewing for a particular sub specialty and they found someone that they really like, but through conversations they came to find out that this fellow didn't feel comfortable performing some basic bread and butter ortho cases. They told the fellow [who is doing his fellowship at another institution] that they needed to do a mini fellowship after he finishes his current fellowship before they would consider hiring them. Even though he is going to be a an "X" orthopedist, he still needs to be competent in general orthopedics. He has [and is] trained at top notch programs but failed to get exposure to procedures. You have to do the procedures in order to master them. The point of residency is to churn out well prepared physicians who can handle general cases in their field. You may end up specializing but programs should be churning out graduates who are competent in the generals of their chosen specialty.

[oceanchild]

You guys know I'm usually the one arguing for reducing hours. I'm fine with extending residency to achieve that (though I'd prefer to see pay go up accordingly - ha!).

But these rules irritate me because the effect at DH's program is the elimination of free weekends. And I am all about weekends. I work on weekdays. The only chance we have to hang out is weekends. It already irks me that he never gets the little holidays that I get. Cramming all his free time into four weeks of the year would truly make both of us miserable.