did you hear about Yale?

[DCJenn]

They have been slammed by the Accreditation Council for Graduate Medical Education because of the hours of their general surgery residency. They may even lose the accreditation if they can get it together. They didn't give their resients the required day off per week, and had them working well over 100 hours a week.



They interviewed the putz in charge and he started making these really lame excuses about why it's important to have them participate in so many surgeries per week. (OK, how much can you actually learn if you're exhausted?!)



It was on npr radio. I'm going to see if I can find a transcript and I'll post it!



Jenn

Here's an article I found on it:



SURGERY RESIDENTS' LONG HOURS DRAW WARNING FOR YALE

The Boston Globe

May 20, 2002

By Anne Barnard



NEW HAVEN - The decision sent shock waves through medical schools and

hospitals.

It left young surgeons at one of the country's most prestigious medical

centers

both alarmed and elated. And to many physicians, it signaled a turning

point in

the debate over the safety of hospital training programs that make new

doctors

work up to 120 hours a week.



The board that oversees doctors' training has decided to strip its seal

of

approval next year from the general-surgery residency program at Yale

University's teaching hospital unless the hospital makes major changes

to

residents' working conditions, Yale administrators said.



The board is concerned that the surgeons-in-training averaged more than

100

hours a week on duty and sometimes spent every other night at the

hospital, say

faculty members who have seen its confidential report issued in March.



Such a grueling schedule has long been considered normal in the world of

surgery, even as doctors in some other specialties move to cut work

hours, but

long hours and heavy workloads have come under increasing scrutiny amid

growing

public concern about medical errors. For instance, New York officials

blamed

Mount Sinai Hospital for inadequate care after a man who donated part of

his

liver died from inhaling blood while in the care of a first-year

resident who

was tending 34 post-surgery patients.



Leaders at Yale-New Haven Medical Center and Yale's School of Medicine

vowed to

do all they could to reform the program and head off the board's unusual

action.

Losing accreditation, faculty members said, would be almost unthinkable

for a

top institution: The program would no longer give graduates the

credentials they

need to be certified specialists. Some current residents would have to

redo part

of their training elsewhere. In the long term, the loss would hamper

Yale's

ability to recruit top surgeons and teach medical students, threatening

its

status as a major medical center.



As a result, Yale-New Haven's leaders promise to spend $1 million on new

support

staff to ease residents' burdens. They are betting that the

Accreditation

Council for Graduate Medical Education will relent when they present

planned

changes in August. But in the meantime, the seriousness of the situation

has

riveted faculty at medical centers in Boston and elsewhere - not because

Yale-New Haven's surgery program is unusual, but because it isn't.



''All programs are worried they're going to come under more scrutiny,''

said Dr.

Deborah DeMarco, dean for graduate medical education at University of

Massachusetts Medical Center in Worcester. Trying to preempt a

crackdown,

hospitals such as UMass and Harvard-affiliated Brigham and Women's are

now

drawing up plans to reduce hours in their surgery programs, even as some

program

directors remain skeptical of hours limits.



Several Yale-New Haven surgery residents said last week that they were

pleased

with the ruling despite the uncertainty it brought. They said it gave

the

program the external push it needed to make changes, from cutting down

on menial

tasks that were crowding out their education to slashing work hours that

made

them fear harming a patient.



''You get to the point where you may be hurting instead of helping,''

said

another resident, who asked not to be named as he grabbed a falafel from

one of

the many food carts stationed outside the hospital to serve rushed

doctors and

nurses. ''You're right on that edge.''



''I'm ecstatic,'' said Dr. Steven Williams, 30, a third-year resident

who once

tried to unionize Yale residents and was one of several surgeons who

reported

the long hours to the council during a review last summer. While faculty

had

recently started paying more attention to residents' needs, he said,

serious

change didn't start until Yale faced losing the accreditation.



Even Dr. Stephen Kavic, 30, who thinks asking for shorter hours ''sounds

like

wanting more recess,'' said the ruling would bring changes he had pushed

for

without success, like relief from paperwork. ''Yale needed an impetus to

change,'' he said.



Yale's new chairman of surgery, Dr. Robert Udelsman, arrived last year

with a

mandate to make the program the best in the world, but instead finds

himself

fighting for its very survival - and acting as an involuntary poster

child for a

reform movement he admits ''was not on my radar screen.''



''Do I think an 80-hour work week is reasonable? My opinion is

immaterial,'' he

said Wednesday afternoon, having worked since 6:30 a.m. to remove three

thyroids. ''I don't have the luxury of a philosophical debate. Surgeons,

when a

blood vessel gets loose, when bad things happen in the operating room,

we're

used to dealing with that. You say a few words, you get it together, you

move

on.''



Now, his mission is clear: make Yale a national model. ''Our residents

were

working too hard,'' he said. ''We have to change the culture. They can't

be

indentured servants, but highly skilled apprentices.''



To some medical educators, the accreditation council's action at Yale is

evidence that after years of debate, medicine's powers that be have come

down on

the side of significantly cutting hours.



In recent years, many in the medical establishment have come to agree

that

financial pressure on hospitals to treat sicker patients more quickly

has made

residents' days more intense, hampered their education, and left them

feeling

like cheap labor. Applications to surgery programs are down.



But the movement to limit work hours has been driven mainly by groups

such as

residents' unions and the American Medical Students Association.

Residents sued

hospitals May 8, saying the centralized program for assigning them to

hospitals

keeps them from negotiating better wages and working conditions.



Fifty-six US representatives have signed on to a bill to cut resident

hours,

modeled on regulations in New York, the only state to limit hours by

law. And

the Occupational Safety and Health Administration is to rule soon on a

petition

asking that doctors be regulated more like pilots.



Medical traditionalists still argue that long hours allow surgeons to

learn more

and give better care by shepherding patients from arrival to discharge.

But many

hospital officials now think the debate has shifted from whether to

limit hours

to how, by how much, and how to pay for it. Next month, the

accreditation

council, which does not now cap surgery hours, is expected to recommend

new

guidelines of closer to 80 hours a week for all residents.



And Yale-New Haven's woes got medical insiders' attention like nothing

else.

Technically, a restructuring made surgery there a new program that could

lose

its status for faults that would usually draw only secret probation.

Still, the

ruling stunned observers at Boston teaching hospitals.



''Wow,'' said Dr. Daniel Lowenstein, Harvard Medical School's dean for

medical

education. ''It's just a great shock and surprise.''



''The fact that such a prestigious hospital was cited kind of took

people's

breath away,'' said Sandy Shea, director of the Committee of Interns and

Residents, a union at Boston Medical Center.



But the debates are far from over. The estimated $1 million in new

annual costs

to fix a single program with 45 residents, less than a tenth of Yale-New

Haven's

total, hints at the enormous expense of compliance.



At Yale, Dr. Rosemarie Fisher, director of graduate medical education,

says the

challenge is to make sure doctors learn as much in less time. And Dr.

Sherwin

Nuland, a clinical professor and surgeon, said the hospital was

''bending over

backward to prove what a good boy it is.'' He said the real problem is

lack of

supervision. ''That's something to squeal about ... not that we work too

long or

don't get paid enough, but that we're here to learn and our teachers are

lying

down on the job.''



Surgery chairman Udelsman marvels at the sea change from when he

finished his

residency at Johns Hopkins in 1989. ''We worked 36 [hours] on and 12

off. That's

just what we did.''



Williams, the third-year resident who sought to change the status quo,

said he

cares about patients as much as the previous generation, but wants to

see

surgeons move away from a workaholic culture.



''They try to change you ... All you're going to be about is surgery,''

said

Williams, who by contrast runs a medical consulting company and owns

part of a

nightclub. ''I'm a very millennium-2000 type of doctor. I love medicine.

I care

about medicine. But I also care about my family and friends.''

The surgery residents we know at UTSW's Parkland hospital have similar schedules (100+ hrs a week) and similar call (often q2). Parkland was put on probation a short while back because of these problems. Nothing has changed....



Jennifer

That guy's comment is infuriating "we worked 36 hours on and 12 off, that's just what we did" - well, *SORRY* buddy! Get a life! I am SO SO SO SO SO *sick* of these "traditionalist" surgeons whose life revolves around surgery. I am happy about this - and still skeptical about what will actually happen as a result. I have heard whispers that this program might have some "changes" this next year but I'm not holding my breath. They will probably do something really whacked like give them a tuesday off - so that you still can't have an entire weekend off. Ever.

Well, after we left UF, their ID program was put on probation for the same reason....and then a few months later, the ENTIRE internal med program including all fellowships was put on probation by the accrediting counsel.



The bottom line in my eyes is that they may have worked those same shifts years ago, but that doesn't make it right. Also, with changing insurance regs, etc....interns and residents are doing more admits and discharges each day.....the lengths of stays are much shorter and there is a great deal more work to be done....you don't have the benefit of following a patient for a week...you are discharging them after a few hours and admitting someone else.....etc...



Kris
"I may not have gone where I intended to go, but I think I have ended up where I intended to be."
Douglas Adams