Will the new residency guidelines be enforced?

The verdict is in...residents aren't supposed to work more than 80 hours a week or longer than 24 hours...will it be enforced by residency programs???

hahahahahahhahaha...you are kidding me, right?

I asked my hubby about this last night. His response was I don't think that will happen, especially not for surgery.

[Phoebe]

Its official, my husband's program has changed their standards and are sending fellows who are on-service home post call. My husband actually is disappointed about this because it means he will have to come in a cover random days for other fellows when he is supposed to being research. Although they are complying, it doesn't sound like they have come up with a good system to replace the current one.



I guess one of the major contributors to the lawsuit is from a nearby hospital so the programs here feel extra pressure to make changes.



Jennifer

Wow! I'm curious about how this will affect the programs over the long-term....I also wonder if the first thing to be cut will be moonlighting :/ ?



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

[Amiens]

I talked to Matt regarding this topic. It's funny, he has mixed feelings- he part for the hour restrictions, and part against it. He is understanding as to why there have been limits put into place, but he also understands the perspective of wanting to finish. He thinks it will get inforced, and the only way around it is to open up more residency spots, which means that pretigious programs like Harvard, John Hopkins, etc. will have to spend less money on research, cut salaries of attendings to hire more residents.



He thinks that Anesthesia won't be affected too much, as most programs abide by the law set in place by the governing board requiring residents to have 24 hours off post-call. If programs aren't abiding by it then the 80 hour limit has just forced them to do so, ie Virginia Mason, Yale.



About moonlighting, I know at CU, as a first year you are forbidden to do so. You are allowed your R2 to do it as long as you have passed Step 3, and have dept permission. Here at Univ Wash, they "advise" you not to moonlight until your R3, but you can moonlight your R2, HOWEVER, you have to have passed Step 3, have a WA medical liscense (which you pay out of pocket for), have dept permission, and you have to have your own malpractice insurance. Hmmmm, doesn't sound worth the money to us at this point- Step 3 alone is going to cost Matt $500!!! I know that the WA liscense is expensive, and let's not discuss him taking out his own malpractice.



Crystal

[Phoebe]

I hope it is enforced. We'll see tomorrow what happens if my dh gets sent home post-call or not. He said that you either get sent home or can't give any patient care after 24 hours. He may have to stay and round.



Jennifer

[Phoebe]

I hope it is enforced. We'll see tomorrow what happens if my dh gets sent home post-call or not. He said that you either get sent home or can't give any patient care after 24 hours. He may have to stay and round.



Jennifer

[DCJenn]

There's an editorial in today's San Antonio Express News agreeing that resident hours should be limited. The editors ended it by saying something to the effect thateven withthe limitations, residents still work twice as many hours as the rest of us.



Jenn

[Phoebe]

It isn't taking effect in our area. My dh is still at the hospital post-call. I am fired up about this! Not necessarily that they haven't followed the rules, but because the inept fellowship director hasn't followed through her responsibility to institute the regulations. She sends out an email to all the fellows with the guidelines attached and says they need to discuss it as a group. Then she corresponds with one or two fellows to say it is going to happen. Nobody knows what is going on, there is no plan in place and nothing is being done. The ones who will get sent home are the fellows who complain because the squeaky oil gets the grease around here. Of course my dh won't say anything. The idiotic director never follows through with anything. I wish she would have never brought it up. This place is unorganized.



Sorry I am venting because I dont like the way they handle situations here. It must be my management background coming out.



Maybe something will happen down the line.



Jennifer

[Amiens]

I was talking to Matt- this subject is an ongoing conversation in our house-



I didn't realize this but the new guidelines are not only that residents can't work more than 80 hours, but they cannot work for more than 24 hours. So the set-up is just like what the ABA and ASA has set up for anesthesia- 24 hours on, 24 hours off.



I am starting to think it won't work. I think in order for it to work- 1- programs will have to hire more residents or hire more attendings. Matt was telling me programs receive on order $100,000 per so many residents, it sounds like it is grant money to me. Either the attendings will have to take a pay cut, which I don't see happening, a cut in research or a pay cut in the residents' pay.

2- the attendings are not affected by the new standard, which means, if the program doesn't hire more attendings or take on more residents, the current attendings will be worked into the ground. I think you will start to then see a higher rate of burn out from these attendings. One good thing is that you may get attendings sick of working the long hours at the hospital, they quit, and move to a rural community to practice. This would be a good thing as rural communities are hurting for trained specialists.

Matt was saying he doesn't see a solution to the problem. It is a lose-lose situation for the residents. He believes while yes residents in surgery and IM will be better rested, that after training is completed that they will have to suffer the consequences while they are an attending. He thinks the solution lies with the med students themselves- if you don't want to work long hours, don't choose a specialty that forces you to, figure out what your priorities are and choose something that suits them. If you want to do a specialty in which the hours are long and hard, then don't choose a program that is known for abusing their residents.



In the upcoming year, I think, we will see more and more programs loose their accreditation, and once this happens most likely the GME will be forced to go back to the old standard.



I will get off my soap box. I hope I didn't step on anyone's toes.



Crystal

Well, as unappealing as it sounds, I think that it means that they will have to increase the time spent in residency a year or so...



In europe, residencies are longer, but pay is also greater. Additionally, to uphold this kind of a system, medical school would simply have to become less expensive (yah, I see THAT happening ) so that medical families would not have such an enormous debt!!!!



my .02



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

[Meenah]

Jennifer,

This is where you are supposed to vent!!!!

Luanne

Jennifer,



I didn't mean to leave your post unanswered...I'm sorry that it seems like things aren't taking effect...that really stinks! When you first mentioned that changes looked like they were being instituted, my cynical hubby said "that won't last"... I really had hoped for you that it would!



One of the articles for the Sept/Oct edition that is in the works is interviews with various program directors about the changes and the problems in instituting them fro their perspectives....any other suggestions and I'll take them. If anyone wants me to try and interview the program director at their program (hehehe) let me know...





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

[Phoebe]

Thanks Kris-



The procedure seems to be ongoing. They held a meeting with the fellows today which my dh was unable to attend because he had to cover the unit. There was a lot of arguing going on amongst the fellows vying for their point-of-view. They are supposedly going to institute fellows who are working in the unit and post-call going home. Other fellows will have to sign up to cover those post-call days which will pull them off of protected research time. The incompetent director said it was going to start next July 1st. 1st and 2nd year fellows are trying to get it instituted earlier so they benefit this year. The 3rd years including my dh won't benefit from it because their NICU time is done after this month. It will only cut into their research time and be a pain in the you no what if they do it this year.



The fellowship director claims she is only taking ideas now and no decision has been made. This is because she is afraid to stand up to anybody and make a decision on her own. Around here the squeaky oil gets the grease and that is going to be one of the 2nd year fellows.



So your husband is right Kris- It won't last or nothing will become of it probably.



Jennifer

[houseelf]

I haven't heard a lot of talk of the new guidelines around here. The joke is that these new 80 hour work week caps will mean that my dh is done with his work week by Thursday! Yeah, that is going to happen.



I would love to believe that this is going to fly but I'm pretty skeptical.



Kelly