New intern work restrictions

[Sheherezade]

What I don't think the people making these regulations get is the workload is the workload. It is consistent. IF anything, it gets heavier in terms of larger patient volumes coming in to an institution as the baby boomers age. So, if you cut back on the intern hours, where does that work go? I can tell you, the hospitals are NOT keen to hire NPs or nurses to fill in the blanks. DH's program finally did and it took 4 years of lobbying to make it happen. So, when the intern isn't there, do they give that work to the residents above? What if they are over the limit, too - stretched to the capacity of the 80 hour work week? Fellows?? They are now regulated too. So, it ends up with the attendings. Who quit - and go private where they make more money, work less and don't have to teach or serve on committees.

The only solution to the workload is MORE residents. The solutions to training time is longer residencies. Both of these mean less money for the system because they will have to pay out more. I think economics are winning now over patient care. When they figure out how to relieve the economic pressure, they might consider adding more staff. Isn't it funny how that solution never comes up when they talk about overworked residents? More help? Nah.

[DCJenn]

Angie-

More residents is the other area that needs to be addressed. Back in the day when the HMO was going to change the world and the medical schools all reduced the numbers they took, the shortages weren't anticipated. I'll bet the admissions numbers haven't been increased to previous levels.

It's scary.

Jenn

PS- I can't imagine my husband having a weekend off. If he's on-call then he's in all weekend. Period. If he's off-call the only time he's free to read eegs and emgs are the weekends. I can count on one hand the number of complete weekends he's been off as an attending. and during residency and fellowship? That's just such a blur of ugly but there weren't too many. (he did his residency in peds for those who haven't been around that long- 3years of peds before the 80 workweek and 3 years of fellowship after the 80 hours. 80 hours was cake coimparitively.)

[niener]

What I don't think the people making these regulations get is the workload is the workload. It is consistent. IF anything, it gets heavier in terms of larger patient volumes coming in to an institution as the baby boomers age. So, if you cut back on the intern hours, where does that work go? I can tell you, the hospitals are NOT keen to hire NPs or nurses to fill in the blanks. DH's program finally did and it took 4 years of lobbying to make it happen. So, when the intern isn't there, do they give that work to the residents above? What if they are over the limit, too - stretched to the capacity of the 80 hour work week? Fellows?? They are now regulated too. So, it ends up with the attendings. Who quit - and go private where they make more money, work less and don't have to teach or serve on committees.

The only solution to the workload is MORE residents. The solutions to training time is longer residencies. Both of these mean less money for the system because they will have to pay out more. I think economics are winning now over patient care. When they figure out how to relieve the economic pressure, they might consider adding more staff. Isn't it funny how that solution never comes up when they talk about overworked residents? More help? Nah.

Yes, this exactly. This is one major issue DH has with the new regulations (which he hates, btw). Especially in surgical and surgical subspecialty programs where you only have 3 or 4 residents in each class -- that's not a lot of people to choose from to cover a service 24/7.

[oceanchild]

Ok, I know this thread kind of fizzled, but I feel like I need to defend my weekend issue. On a Q4 month currently there's a golden weekend. The way DH's program is rewriting the schedule, there will be no golden weekends for the interns on those months (yes, this part of the restrictions only apply to interns). So if that were what we would face next year, I would be annoyed. I'm not saying every weekend. I'm saying the two weekend days in a row on a Q4 month. That's all.

On extending residency, I think what might work in peds is some coordination with the fellowships, which at this point are probably longer than they need to be unless you really want to do research. But obviously that's specialty dependent.

And DH's program has already asked to add interns.

[BonBon]

Bearing in mind that I met the husband just as he finished residency (phew!), I'm wondering how often residents are doing work like Michele described. Seriously, a resident should not be making reminder calls or scheduling appointments. How much time is being wasted on stuff like that, that could be MUCH better spent on actual patient care?

[poky]

Bearing in mind that I met the husband just as he finished residency (phew!), I'm wondering how often residents are doing work like Michele described. Seriously, a resident should not be making reminder calls or scheduling appointments. How much time is being wasted on stuff like that, that could be MUCH better spent on actual patient care?

I also wonder that. My cynical brain says "as much as they can get away with making them do, since they're cheaper than clerical staff"

[DCJenn]

None in my husband's residency. It's all automated through a separate organization. A highly efficient automated triage system that is augmented by on-call triage nurses. It's pretty fantastic to be honest. Although, HE would prefer to have actual control over his schedule as an attending. It's kind of annoying for him as an attending- great when you're the customer though!

Jenn

[SuzySunshine]

My DH acts as a junior staff this year, his chief year, and he's not doing any of his own scheduling appointments or follow-up calls. He lets his secretary know when he can open her calendar and the scheduling pool schedules the patients either he approves (new) or follow-ups. He also has a nurse that takes all of his patient calls and only bothers him if she needs to. He didn't do any of this as a younger resident either because then he was working for a staff and that staff had the same kind of support.

[Sheherezade]

The only kind of scheduling that DH did in residency was scheduling call schedules. His paperwork was less than what he does now as an attending. He didn't have to deal with billing, signing a million charts, that kind of thing. Mostly what he complained about were things like pulling labs, etc. but I don't think that is out of line for residents. Honestly, all docs spend WAY more time doing administrative work than ever before - because we have more administrative work than ever before. Billing is complex, quality measures bring more documentation, working with a team of docs requires more paperwork to pass hands. Reducing paperwork would help everyone and reduce costs - BUT it would be "job- killing". After all, getting rid of all those middle managers and paper pushers, streamlining and becoming more efficient - those are jobs.

[oceanchild]

On some rotations my DH has spent a considerable amount of time scheduling follow-up appointments or coordinating home care. Highly variable. And one of his least favorite things.

[alison]

My dh has sat in the VA filling out meal coupons for patients for the cafeteria!

[MarissaNicole]

I haven't had time to read all the responses, but for DH's program they are only on their specialty for 4 months of their intern year. A 16 hour day is a good day when he is on service. A bad day is 16+ hours. But when he stays past 16+ hours its really more to help wind things up, he isn't necessarily "needed" but they like to be a team and finish things up together, so that the on-call person isn't totally overwhelmed and/or one or two people are stuck leaving late. DH also looks at it as the more time he is at the hospital, the more he is learning. Sure he has days that he is annoyed, but overall he views everything as a learning experience.

In regards to clerical stuff, DH's program is too short staffed to have residents doing that. On his very first day on service they needed all the senior residents in the O.R. and they needed the junior residents in clinic, so he got the pager and was responsible for the floor. They literally threw him in the fire on the first day.

[SuzySunshine]

DH does spend some time coordinating home care, I don't think its a lot but he does have to do some of the leg work to make sure his patients have what they need so they can get sent home or to a nursing home.

[L.Jane]

I have not read through all the responses, but it turns out DF's hospital is testing out the new hours restrictions starting next month. Basically the interns will be on night call for a week and then switch over or something. I didn't exactly understand how it was going to work, probably because J didn't seem to understand it fully himself, so his explanation wasn't that clear. We will see how things go next month.

[NYCHoosier]

Bearing in mind that I met the husband just as he finished residency (phew!), I'm wondering how often residents are doing work like Michele described. Seriously, a resident should not be making reminder calls or scheduling appointments. How much time is being wasted on stuff like that, that could be MUCH better spent on actual patient care?

DH is not doing that type of work. I think one reason his program is able to be "ethical" in terms of the hours, still get amazing training AND have time for moonlighting is that the residents don't do scut or administrative work.
A doctor from my home church (the county coroner, actually), shrugged off the 80-hour work week as wimpy, but when he described his Q2 call schedule back in the day, it seemed like there was a lot of tasks given that didn't advance the learning/practice of medicine. That's not to say he's not an excellent physician, but there are ways to cut hours without sacrificing the training.
That said, the 16-hour limit does seem a little short.