What changes are your SO programs making?

[Amiens]

In this in regards to the new work hour regulations set up by the ACGME (I think I got the abbreviation right).

Anyway, Matt was telling me last night that the anesthesia program has finalized the changes that will be implemented beginning July 1.

The biggest change is that on ALL rotations this including ICU and "non-OR" months, anesthesia residents are to be out of the hospital by noon on post-call days. So instead of working 36 hours in the ICU it will be no more than 30 hours. This gives more than enough time for to transfer patients to the on-call team, etc.

Matt is excited about it, because when he starts doing more overnight call next year for the OR- there will be some days he won't have to go in until 4 pm, and then he will be done by 6 am the next day, and then have his post-call day off. As far as ICU goes (he is doing an ICU month now), he gets done at 2 pm, so it will mean he is home 2 hours earlier.

I was just curious if anyone knew of changes their SO programs are making to accomodate the new regulations.

I am sure it will vary from specialty to specialty.

Crystal

[SueC]

I don't know--I'll have to ask. Does it apply to fellows, too? If so, then I'm sure my husband's program is in violation when he is on the unit. I've never actually added it up but I'm sure he is over 80 hours!

[DCJenn]

Well- It's turning out to be a huge nightmare at the moment. They're ready but it's going to really have an impact on the kinds of experiences that the peds interns and residents are exposed to. At the same time, it's good because on post-call days, my husband will theoretically be able to be home after rounds. The Air Force Surgeons have already applied for the 10% increase in hours so they'll more than likely be doing 88 hours.

Logistically, it's a huge drag because there are already limits on what service are allowable for leave (inpatient months, clinic months- etc- no leave) and now they are saying that they must have four four-week specialty rotations that aren't 'leavable' either- so for the three years, there's about two weeks a year that they will actually be able to take their leave. I'm so glad we only have six more months!

Jenn

[SueC]

Well, I talked to my husband tonight and for the residents they are making changes but for some reason it doesn't apply to the fellows. He said there weren't enough fellows to allow for an 80-hour work week. Boy, that sounds so crazy that anyone would ever work more than 80 hours in a week!!!

[Amiens]

Before Matt's third year of medical school when he did his surgery rotation, I never knew that it was possible to work 110 hours a week!

[SueC]

Yes, I remember Frank's month of surgery during his 3rd year of medical school--that was a rude awakening! I was so thankful after that that he decided not to go into surgery! Not that being in the ICU seems to be much better...

[mommax3]

My husband is jealous that this is going into effect AFTER he has finished residency. He worked more than 100 hours for many, many weeks during residency and some weeks it was 125 -- yes, I counted it up. He doesn't understand how the current OB/GYN residents are going to get the experience they need, though, without making the residency last more years. I am glad these regulations are finally in place -- hopefully medical families will be stronger as a result.

Sally

[Meenah]

I wish this applied to attendings!!! My husband came home at 11:30 last night was called at 1am by the resident and went back until 4am. Thank goodness he loves critical care, and doesn't think twice when they need him, but I worry about him, he isn't 30 years old anymore!!!!
Luanne

[houseelf]

I really don't know how our program is going to make the new caps fly. Although I hate to admit it, it will be pretty difficult for them to comply. There simply aren't enough surgery residents as it is. I'm sure that they've applied for the 10 % differential, but even 88 hours a week wouldn't approximate actual demand. The program has consolidated services so that one resident now covers multiple services (also referred to as "super call" in our household). It will be interesting to see. I wonder if coercion will occur...i.e. not filling in time cards with actual hours, not logging cases, etc. I'm sure that it wouldn't be the first time.

Have I become cynical or what?

Kelly

[Meenah]

Kelly,
You sound realistic not cynacil to me.
Luanne

The program here in KC actually thought that they were already in compliance! They have been having all the residents fill out "surveys" which amounts to a paper time sheet. They had a rude awakening when they totalled it up for the month. I have kept track of the hours before and it can get up into the 110+ range, but thankfully it is usually followed by a slow week of only about 80-90!
It is making lots of work since this is coming around when they are also trying to implement HIPAA as well. That is making more work for the attendings, residents get to write orders and manage their patients, but the attending has to come back around and sign off on the orders. Along with other quirks that are halting some meeting since it would conflict with patient confidentiality.(ie. morbidity & mortality) Ah, you gotta love politics though...