New intern work restrictions

[Deebs]

DH now wishes he didn't even have the restrictions that were in force when he went through training. He's had several shifts (at multiple institutions) where a blizzard has kept someone from coming in until a couple of hours late to take over his shift, a patient codes at the end of a shift, so he has to stay late, or he has something else come up where he just has to "power through." He thinks having experience working longer hours or harder shift times WHILE UNDER SUPERVISION (during training) is the only thing that prepared him well for those occasions. Where he trained, an attending was on each case with a resident (as is legally required, but not always done), so he had a safety net if he made a mistake. He is also very frustrated with new interns who just don't seem to have the same work ethic they did a couple of years ago. You can teach people procedures and medical knowledge and skills. Going above and beyond is more difficult to teach, especially when there are so many protections now in place.

[Michele]

I thought there were studies that showed you can't prepare for sleep deprivation and exhaustion?


Maybe they need to examine what fills a residents day/hours. I suspect that an increase in support staff would allow the residents to use their time more efficiently. For example, part of Russ' day each week during residency was spent calling patients to confirm their appointments for surgery, and to schedule other patients for empty slots. The hour issue wasn't an issue for him, and likely not any ophtho residency, but I bet there are equivalent time sucks for other residencies.

[PrincessFiona]

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.

I completely agree. What needs to be addressed now is how to give the residents the skills that they need and I would argue that extending residency for 1-2 years would meet that goal. I know we are all eager to get out into the real world and earn real salaries, but there is an issue with docs coming out of training now who are unprepared. Our OB department has struggled with that and some of the older docs find themselves doing a log of handholding. Physician and patient safety has to be addressed and now it has been. Next up? Making sure the docs are prepared to do the work post-training.

Kris

[Sheherezade]

...there is an issue with docs coming out of training now who are unprepared. Our OB department has struggled with that and some of the older docs find themselves doing a log of handholding.

Here, too. In fact, the last two years have filled the department with a lot of newbie attendings - and patient care has plummeted. SO much so that they have pulled the new attendings off duty and put the old guard in charge of cases that they never used to cover. Surgical errors are no joke. They need to extend training years.

[Mrs. MD, Esq.]

I won't lie...looking at it purely from a significant other aspect...I am a little bummed about the likely loss of weekends...

[SuzySunshine]

So it actually won't affect the NSG program at DH's institution because interns aren't on the NSG service except for a small six week block. What it will affect are the rotations they do do during their intern year which are TCGS, Neurology, and I can't recall the other two quarters they do off of the top of my head. Now I'm not sure how it will affect where we're going for fellowship next year because I have no idea how their system works but DH is supposed to be functioning as a staff there not a resident so hopefully it doesn't affect him his last year in training.

[GrayMatterWife]

Are they applicable to NSGs? They may be carved out, just like they have an 88, not 80, ceiling. Honestly, it doesn't matter. They'll just "be creative." You can't NOT do the work. I hope they are carved out.

[Ladybug]

I second Michele. It's the most viable solution to make the hours adequate. More money, more money...more jobs? Labor just ain't as cheap as it used to be

[ides]

I thought there were studies that showed you can't prepare for sleep deprivation and exhaustion?


Maybe they need to examine what fills a residents day/hours. I suspect that an increase in support staff would allow the residents to use their time more efficiently. For example, part of Russ' day each week during residency was spent calling patients to confirm their appointments for surgery, and to schedule other patients for empty slots. The hour issue wasn't an issue for him, and likely not any ophtho residency, but I bet there are equivalent time sucks for other residencies.

YES! If major time sucks were removed I don't think an increase in training would be required. I do think they need more residents to make this work. Dhs hospital runs 24/7- like most- and the residents are the ones who staff the hospital for the most part. There just aren't enough of them to cover everything with less hours.

For those who say the shorter hours leave new attendings missing experince I'd argue that it's due to a substandard program &/or lazy resident NOT less hours. Some programs barely let residents do anything in the operating room & some programs just lack in certain areas.

[Vanquisher]

I think you all know how I feel about this, so I will refrain from my big long soapbox, but I just want to say that 120 hour work weeks did shit to prepare my husband for his real world practice. I realize that specialties are different, and OBs especially have to put in long hours throughout their careers. All 120 hours did for him was suck the life out of him, hurt his health, my health, our mental health, etc. It was a take, take, take relationship, and did little giving as far as learning. DH has not learned how to be sleep deprived. I don't think you can learn that. It took it's toll on him, and now, he has a really difficult time staying up to do charting and things. Most nights he passes out on the couch. I firmly believe residency could be and should be more humane. It can be longer (with better pay), but it needs to be more humane.

Sure he had his share of complex cases at 3:00 a.m., but MOST complex cases or trauma cases and bread and butter cases were during the daytime hours for ortho. Most cases could hold off for a few hours to start. 36 hour shifts are just barbarism.

Okay that was longer than I wanted, but I just have such a hard time holding my tongue on this.

[DCJenn]

The answer is not to go back to the insanity of the 120 hours- no one needs to crash their car due to sleep deprivation- or kill a patient for that matter. That said, there have been some unbelievably unprepared newly minted peds attendings overthe past few years. (civilian and military residencies- doesn't seem to make a difference)

The only way to ensure that residents have adequate training is to extend the time in.

Jenn

ETA: and remember, if you're in the trenches about to graduate, you don't know what you don't know. You would have no way to know what you don't know.

[SuzySunshine]

Are they applicable to NSGs? They may be carved out, just like they have an 88, not 80, ceiling. Honestly, it doesn't matter. They'll just "be creative." You can't NOT do the work. I hope they are carved out.

The 88 is program specific, DH's program hasn't had the program exemption for a couple of years.

[oceanchild]

Are they applicable to NSGs? They may be carved out, just like they have an 88, not 80, ceiling. Honestly, it doesn't matter. They'll just "be creative." You can't NOT do the work. I hope they are carved out.

The 88 hours is not specific to nsg - any program can request it. And that's still the case.

It doesn't look like there are exceptions to the 16 and 24 hour shifts.

ETA: Sorry, cross posted with Cheri!

[GrayMatterWife]

The 88 hours is not specific to nsg - any program can request it. And that's still the case.

It doesn't look like there are exceptions to the 16 and 24 hour shifts.

ETA: Sorry, cross posted with Cheri!

Thanks! I didn't know how the 88-hour thing worked.

I think I come from the opposite point-of-view on the hours restrictions stuff.

[scarlett09]

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.

This is going to be my issue as well next year. I know peds hours are not as arduous as other specialties, but I do look forward to the weekends that I can have time with DH. Time with him where he doesn't fall asleep on the sofa at 8PM. But one of the reasons why I love this website is because it gives me perspective. I realize that both the type of residency we are in and the time in which our residency is taking place make us pretty damn lucky because it could be a whole hell of a lot worse. I still want a better residency experience, but I will make do with what I have. Take away something and I will be disappointed. Thankfully, we will only have one year of the these new hours requirements.

Everyone's comments about newbies out of training needing their hands to be held during attendinghood had me thinking. I'm wondering if now some of these people (non-traditional graduates aside) are part of the Millennial Generation - I know my DH was born in 1983, just on the cusp of its beginning (depending upon what definition of Millennial one uses). People born during this time period had helicopter parents and had their hands held a lot, far more protections around them than their parents had or even those who were born a few years before them. Perhaps this is something that some people have become accustomed to - having their hands held and not doing as much "hard work" as their predecessors so that they don't know how to function when no one else is hovering over them?