What do you make of this piece on duty hour restrictions?

[Meenah]

Kelly,
I could have written your post with a few changes here and there. DH is way before the work hour restrictions and he is super cool in emergencies. He is triple boarded, IM / Pulmonary / Critical Care and NOTHING rattles him. BUT, his personal life did take a hit.

[medpedspouse]

[MENTION=792]houseelf[/MENTION]
K, you said much better than I could have but feel pretty much the same. The work-life balance sucks but that IS the lifestyle of someone in medicine. I have a book from 1898 (yes, 18) that talks about the physician lifestyle and some things do not change because they cannot change - it is the nature of the profession. DH's program got in trouble for work hours...and this was BEFORE the 80hr work rule. It was hard, and I rarely saw him. However, he credits that time as learning the most.

Made me think of a convo we had in a curriculum meeting. Students did not want to have multiple tests on one day so they were proposing spreading them out. Only problem was that some may have to be on a Saturday. The student reps were quick to remind us that weekends were not an option because students wanted to be with their families. You could have heard a pin drop until one of the faculty spoke up and stated that when he went into medicine, he went in with the understanding that people got sick on weekends, holidays and birthdays.

I think our current generation of trainees do view the work-life balance of medicine as doable. I, frankly, would love that. Perhaps it is no longer up to us to solve this issue - maybe those now in training will be able to do so with fresh eyes.

[spotty_dog]

I hate to negate y'all's experience with longer work hours leading to better doctors, but honestly I don't really buy it. I felt like we had a pretty decent work/life balance during residency, but I can point to about 70,000 people (the population that feeds DH's hospital) that would very much like to have my guy by their side in a true emergency.

If I had to draw conclusions, I would say it's more a growth mindset vs. fixed mindset. Students in the last decade or more are being taught to play to their own strengths, and that if they don't have a skill it's because someone didn't teach them adequately. My husband has always worked to build up his own weaknesses, and if he doesn't have a skill it's because he hasn't practiced it enough. If necessary, "practice" happens when he's thrown into the deep end and just makes the best of a bad situation. That's how I'm raising my children too.

[OrionGrad]

I'm 99% on the side of work hour restrictions being a good thing, mainly because we got through residency in one piece and I'm not sure that would have been possible before. But, DH feels like he hasn't had the opportunity to perfect certain things he'll need to do frequently in practice (mainly, anterior hips), so he's now having to seek out weekend courses put on by the implant companies to get more experience. (Usually flying in/out on Saturdays, which sucks.) So even though it looks like an 80 hour workweek on paper, I think in some specialties it really does take more to be completely competent flying solo.

[medpedspouse]

I'm 99% on the side of work hour restrictions being a good thing, mainly because we got through residency in one piece and I'm not sure that would have been possible before. But, DH feels like he hasn't had the opportunity to perfect certain things he'll need to do frequently in practice (mainly, anterior hips), so he's now having to seek out weekend courses put on by the implant companies to get more experience. (Usually flying in/out on Saturdays, which sucks.) So even though it looks like an 80 hour workweek on paper, I think in some specialties it really does take more to be completely competent flying solo.

This is kind of what I was thinking. I can see how some specialties lend themselves to fitting within certain time limits. A friend still in fellowship gets frustrated with not getting to be involved in some cases due to the restrictions. Another is perfectly content with her learning opportunities. One is derm one is a surg subspecialty.

[SoonerTexan]

I don't think I really have much of a dog in this fight now that intern year is over and DH is in Radiology...I don't think they've ever been hugely affected by hour limits.

But...he has mentioned more than once recently how high the volume is here and that he knows he has seen stuff (like a CT of a dude with elephantitis sp?) that you would just not see often outside of a large academic center.

So I wonder how other factors of the program contribute to Do I feel ready in X years?"


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[alotofyarn]

I asked hubby about it - he doesn't think that overall it's hindered him at all, and he felt like even a general surgery resident with restrictions (who follows them) is going to come out prepared.

[Sheherezade]

I think it's an issue in OB/Gyn because they have to cover OB and learn surgery during the same years. They do not have enough time in surgery rotations because the 24 hour Labor and delivery coverage is hard to schedule. It eats up a lot of duty hours.

Also, since my husband is in the most surgical of the OB-Gyn sub specialties, he probably has the most complaints about lack a of surgery time. Most residents get very limited time rotating through Gyn onc during their four year residency yet generalist OBs are first line for seeing cancer cases, and many treat cancer patients. I'm sure he thinks it would be a lot better if they knew what they were doing, but in general he just says they need to know to refer to Gyn onc. The idea that they are potentially treating cancer patients with only 2-3 rotations of onc training is scary.


Angie

[Flynn]

I totally agree that DH's long and unmonitored hours during training did horrible things to his health, well being, his family and his relationship with his wife. It was 9 years in a strange lousy limbo of sorts. It sucked on many many levels.

While I can only comment on his area of medicine, significantly lower hours is drastically effecting both general surgery docs and CT docs. There is an unreleased study that in DH's former program, GS residents do less than half of the procedures they used to do. LESS THAN HALF. In order to keep hours down they do much less trauma in general. They are much less prepared if patients code. In CT fellowships the numbers are similar. There is a joke in DH's world that you NEVER hire a CT surgeon for a job unless they have 5+ years somewhere else. The joke is that they need to "finish training and kill people somewhere else while they learn." Additionally, when docs are done and go into their first job they are rarely mentored like residents and fellows are and practices (even academic ones) aren't set up to watch over both the doc and the patient.

I hated training with a passion that was incredibly unhealthy. With my limited window to DH's world and reading on my own I definitely feel that with some areas of medicine, less hours mean less qualified doctors. Absolutely. Some Docs are still green when they finish training and the repitition necessary to do your job despite the stress involved hasn't happened yet.

Just my two cents.

[mommax3]

In a similar story, my friend had a pretty terrible C section with a seasoned ObGyn that would be material for something like ER or Gray's anatomy. She said when the shit hit the fan, the energy in the room was beyond panicked, except for her 15 year experienced, work horse ObGYn who went into that same quiet focus mode. I know this guy. He has worked his ass off and there is nothing he hasn't seen. THAT is the guy you want at that moment, not the guy who managed work life balance in residency.

My husband and his partner are those guys at their hospital. I can't tell you the number of times in the past 10 years that they have been called in to bail out docs from other practices who don't know how to handle obstetric complications. I don't know the answer, and I wouldn't wish our residency experience on anyone, but the fact is that DH and other docs of his era were better trained after four years than are docs at the end of residency today.



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[Deebs]

We were in the first batch of hour restrictions. I honestly don't understand why they were further tightened. DH saw a LOT, but he was in an ED with 100,000 annual visits (considered very busy) and rotated through ICUs with both very rare and very typical conditions. He's always told that he finds so many zebras. Realistically, his colleagues should find just as many, but they may not have seen what he has. He also started clinical time in his second year of Med school. Beyond that, he called his residency mentors after every shift his first year in practice, as they had asked him to. He meets with physicians all over the world to stay on the cutting edge of medicine. I worry most about those coming out who most want a balanced lifestyle. While it sucks for a home life, his love of medicine and drive to continue learning is what I want from my own doctors.

The reality is, we need a shift in medical training, starting in medical school. Four years of Med school was the norm decades ago before embryology, histology, pharmacology were even included. There is so much more for physicians to learn. How is it possible to cover it in the same amount of time? It isn't. I don't think those revisions can happen until medical school is fully funded.


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[SoonerTexan]

I dunno...I'd argue they are fitting the classroom portion in just fine. It was grueling during some parts but if Step 1 is supposed to be an indicator of having learned all that to an appropriate degree and scores aren't dropping...


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[TulipsAndSunscreen]

I'd argue that they could start the more specialized stuff sooner and that would save time. DH now jokes that he knows almost no "medicine". You can see it as a downside or you could see it as knowing when to consult the appropriate specialty. I don't want a surgeon managing my diabetes...I want him to know to consult endocrinology, etc.

[memyselfandI]

My husband trained before the restrictions and he really notices a difference in resident readiness. Other faculty feel similarly. I don't know what the residents and fellows think bit they aren't really in a position to know.

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