Comments on: Softening of the surgical residency? http://www.kevinmd.com/blog/2006/10/softening-of-surgical-residency.html medical blog Sun, 22 Nov 2009 22:50:49 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: Anonymous http://www.kevinmd.com/blog/2006/10/softening-of-surgical-residency.html/comment-page-1#comment-85867 Anonymous Thu, 29 May 2008 01:40:00 +0000 http://clients.emmense.com/kevinmd/2006/10/softening-of-the-surgical-residency.html#comment-85867 I respect all of you who put in the time to become the great surgeons that you are, however as a PA student embarking on a 5 week rotation as a grown up with a responsibilities it appears that safety would be an issue if one is expected to put in 15 hour days 7 days a week. I presume making a medical error or perhaps driving my car into the guard rail would be frowned upon. Hence what is so unreasonable in having a medical professional that is well rested and ready to operate as opposed to one that is delirious from a lack of sleep and more prone to error. Just my opinion! I respect all of you who put in the time to become the great surgeons that you are, however as a PA student embarking on a 5 week rotation as a grown up with a responsibilities it appears that safety would be an issue if one is expected to put in 15 hour days 7 days a week. I presume making a medical error or perhaps driving my car into the guard rail would be frowned upon. Hence what is so unreasonable in having a medical professional that is well rested and ready to operate as opposed to one that is delirious from a lack of sleep and more prone to error. Just my opinion!

]]> By: Anonymous http://www.kevinmd.com/blog/2006/10/softening-of-surgical-residency.html/comment-page-1#comment-68700 Anonymous Sat, 11 Nov 2006 23:27:00 +0000 http://clients.emmense.com/kevinmd/2006/10/softening-of-the-surgical-residency.html#comment-68700 When I was a resident..we didnt have no stinkin lifestyle..we lived in the hospital..ate in the hospital..if you wanted to take a crap you damn well better have done it on your own time...I even had to disimpact myself once...these young kids today dont know what rigorous means...i took ATLS when it was only "S" When I was a resident..we didnt have no stinkin lifestyle..we lived in the hospital..ate in the hospital..if you wanted to take a crap you damn well better have done it on your own time…I even had to disimpact myself once…these young kids today dont know what rigorous means…i took ATLS when it was only “S”

]]> By: WilliamManginoMD http://www.kevinmd.com/blog/2006/10/softening-of-surgical-residency.html/comment-page-1#comment-68170 WilliamManginoMD Wed, 25 Oct 2006 11:25:00 +0000 http://clients.emmense.com/kevinmd/2006/10/softening-of-the-surgical-residency.html#comment-68170 Prior to entering the field of anesthesiology I did several years of surgical training.<br/><br/> The prevailing attitude was that the main problem with being 'on call' every other day was that you missed half of the good cases.<br/><br/> When I was an anesthesia attending at Baylor, in Houston, Mike DeBakey used to keep his surgical ICU rotations 'in house' for long periods of time.<br/><br/> There is something to be said for following the same [ your ] patients-on whom you've operated- until they got out of the unit and past any residual complications.<br/><br/> This continuity of care makes sense.<br/><br/> Sir William Osler said,"The masterword in medicine is work."<br/><br/> The more cases you do-the better you are-usually. This goes for exposure to "cases" in any specialty.<br/><br/> Maybe it is true that doctors need to be like sequestered 'monks' during their training periods.<br/><br/> There are legitimate arguments on both sides of the coin. <br/><br/> The fact is-that if you have library time during the daytime hours in your residency- and lots of conferences and less time running around taking care of sick people's complications and needs-then you may be in the wrong program.<br/><br/> You can dispute this all you want. Reading should be done at night and on weekends. <br/><br/> The sad fact is that if you are not working your ass off-you are getting shortchanged-in general-on your education.<br/><br/> You may disagree with me-but the fact remains. Prior to entering the field of anesthesiology I did several years of surgical training.

The prevailing attitude was that the main problem with being ‘on call’ every other day was that you missed half of the good cases.

When I was an anesthesia attending at Baylor, in Houston, Mike DeBakey used to keep his surgical ICU rotations ‘in house’ for long periods of time.

There is something to be said for following the same [ your ] patients-on whom you’ve operated- until they got out of the unit and past any residual complications.

This continuity of care makes sense.

Sir William Osler said,”The masterword in medicine is work.”

The more cases you do-the better you are-usually. This goes for exposure to “cases” in any specialty.

Maybe it is true that doctors need to be like sequestered ‘monks’ during their training periods.

There are legitimate arguments on both sides of the coin.

The fact is-that if you have library time during the daytime hours in your residency- and lots of conferences and less time running around taking care of sick people’s complications and needs-then you may be in the wrong program.

You can dispute this all you want. Reading should be done at night and on weekends.

The sad fact is that if you are not working your ass off-you are getting shortchanged-in general-on your education.

You may disagree with me-but the fact remains.

]]> By: Anonymous http://www.kevinmd.com/blog/2006/10/softening-of-surgical-residency.html/comment-page-1#comment-68111 Anonymous Mon, 23 Oct 2006 23:00:00 +0000 http://clients.emmense.com/kevinmd/2006/10/softening-of-the-surgical-residency.html#comment-68111 you know what. im a surgical resident who didnt make it. and i loved what i was hoping to do. you cant imagine the feelings that you have for the rest of your life from leaving a program. <br/> i am all for it. if someone goes 6-7 years i think they would be a good surgeon. maybe they wont do the most challenging of provedures. but im sure they woudl be competant to do routine operations. <br/>i have already known pathology residents who added a year onto their residency. if anything they can maintain a healthier lifestyle. <br/>when i was a surgical resident i was miserable. i was on call every 3rd night. and when i wasnt on call i was at home on call. its no fun being called into the hospital at 4 in the morning. i did not have a balanced life. i think it would be safe and effective to let them do a flexable program. do it. you know what. im a surgical resident who didnt make it. and i loved what i was hoping to do. you cant imagine the feelings that you have for the rest of your life from leaving a program.
i am all for it. if someone goes 6-7 years i think they would be a good surgeon. maybe they wont do the most challenging of provedures. but im sure they woudl be competant to do routine operations.
i have already known pathology residents who added a year onto their residency. if anything they can maintain a healthier lifestyle.
when i was a surgical resident i was miserable. i was on call every 3rd night. and when i wasnt on call i was at home on call. its no fun being called into the hospital at 4 in the morning. i did not have a balanced life. i think it would be safe and effective to let them do a flexable program. do it.

]]> By: Anonymous http://www.kevinmd.com/blog/2006/10/softening-of-surgical-residency.html/comment-page-1#comment-68093 Anonymous Mon, 23 Oct 2006 05:30:00 +0000 http://clients.emmense.com/kevinmd/2006/10/softening-of-the-surgical-residency.html#comment-68093 sorry I meant aamc data, not date sorry I meant aamc data, not date

]]> By: Anonymous http://www.kevinmd.com/blog/2006/10/softening-of-surgical-residency.html/comment-page-1#comment-68092 Anonymous Mon, 23 Oct 2006 05:29:00 +0000 http://clients.emmense.com/kevinmd/2006/10/softening-of-the-surgical-residency.html#comment-68092 with regards to the aamc date, although the numbers of applicants to surgery programs is highest this does not mean that all of these applicants ranked surgery first. This is evident in the fact that when you look at figure 2 on page 7 of the report you will see that although there are a higher number of applicants per position, there is still a higher percentage matched who ranked surgery #1 than 4 other specialties excluding transitional years, i.e. there are four specialties more conpetitive than surgery. with regards to the aamc date, although the numbers of applicants to surgery programs is highest this does not mean that all of these applicants ranked surgery first. This is evident in the fact that when you look at figure 2 on page 7 of the report you will see that although there are a higher number of applicants per position, there is still a higher percentage matched who ranked surgery #1 than 4 other specialties excluding transitional years, i.e. there are four specialties more conpetitive than surgery.

]]> By: Anonymous http://www.kevinmd.com/blog/2006/10/softening-of-surgical-residency.html/comment-page-1#comment-68088 Anonymous Mon, 23 Oct 2006 04:00:00 +0000 http://clients.emmense.com/kevinmd/2006/10/softening-of-the-surgical-residency.html#comment-68088 Exactly. So now that we've establsihed for a fact that surgery interest is at an ALL TIME HIGH, then why in the hell would we need to "soften" the residency to attract more candidates?<br/><br/>There is a surplus of candiates for surgery right now. Easing the training makes absolutely no sense.<br/><br/>Expanding the number of residency slots is the right answer. Those who fail to grasp that simple logic baffle me. Exactly. So now that we’ve establsihed for a fact that surgery interest is at an ALL TIME HIGH, then why in the hell would we need to “soften” the residency to attract more candidates?

There is a surplus of candiates for surgery right now. Easing the training makes absolutely no sense.

Expanding the number of residency slots is the right answer. Those who fail to grasp that simple logic baffle me.

]]> By: Anonymous http://www.kevinmd.com/blog/2006/10/softening-of-surgical-residency.html/comment-page-1#comment-68085 Anonymous Mon, 23 Oct 2006 02:43:00 +0000 http://clients.emmense.com/kevinmd/2006/10/softening-of-the-surgical-residency.html#comment-68085 Alot of Medical students view surgery as the only "real" medical practice left, where you repair things and save lives. General practitioners are seen as spending their day on the phone fighting insurance companies, ER docs as babysitting drunks, psychiatrists as being Against Tom Hanks. Alot of Medical students view surgery as the only “real” medical practice left, where you repair things and save lives. General practitioners are seen as spending their day on the phone fighting insurance companies, ER docs as babysitting drunks, psychiatrists as being Against Tom Hanks.

]]> By: Anonymous http://www.kevinmd.com/blog/2006/10/softening-of-surgical-residency.html/comment-page-1#comment-68081 Anonymous Mon, 23 Oct 2006 02:08:00 +0000 http://clients.emmense.com/kevinmd/2006/10/softening-of-the-surgical-residency.html#comment-68081 I'm not a general surgeon, but the ones I refer to work horrendous hours doing excellent work. If you can only do a surgical residency if it is 40 hours per week, no one in private practice will hire you. If they are taking call for 36 hour shifts (and operating at midnight) and you sign in at 7A and out at 7P, you won't be able to find a general surgery job.<br/><br/>Everyone seems to get excited about the work hours of training, but what about the work hours of practice? Therer are far more physicians in practice than in training. Don't they endanger the lives of the citizens of NYC and beyond?<br/><br/>Part of training is having to make decisions when its not 8AM in the morning after a hearty breakfast and a kiss from mom. You develop the skills to use limited data and poor patient communication to make the best of a bad situation. Spoon feeding our young will not help them learn how to deal in those situations. <br/><br/>I didn't like the belittling nature of the surgical clerkship experience either, but the general idea was to take your licks and continue to do the job. That is an important thing to learn in life. To succeed you have to develop the "big belly" necessary to digest the good and bad. I’m not a general surgeon, but the ones I refer to work horrendous hours doing excellent work. If you can only do a surgical residency if it is 40 hours per week, no one in private practice will hire you. If they are taking call for 36 hour shifts (and operating at midnight) and you sign in at 7A and out at 7P, you won’t be able to find a general surgery job.

Everyone seems to get excited about the work hours of training, but what about the work hours of practice? Therer are far more physicians in practice than in training. Don’t they endanger the lives of the citizens of NYC and beyond?

Part of training is having to make decisions when its not 8AM in the morning after a hearty breakfast and a kiss from mom. You develop the skills to use limited data and poor patient communication to make the best of a bad situation. Spoon feeding our young will not help them learn how to deal in those situations.

I didn’t like the belittling nature of the surgical clerkship experience either, but the general idea was to take your licks and continue to do the job. That is an important thing to learn in life. To succeed you have to develop the “big belly” necessary to digest the good and bad.

]]> By: cdclled http://www.kevinmd.com/blog/2006/10/softening-of-surgical-residency.html/comment-page-1#comment-68080 cdclled Sun, 22 Oct 2006 23:55:00 +0000 http://clients.emmense.com/kevinmd/2006/10/softening-of-the-surgical-residency.html#comment-68080 "Demand for general surgery residencies is at an ALL TIME HIGH. If you go by number of applicants per position, then gen surg is harder to get into than every single specialty out there, including derm, rads, rad onc, etc."<br/><br/>He's right. I didn't believe it either so I looked it up on the <br/><a HREF="https://services.aamc.org/Publications/showfile.cfm?file=version68.pdf&prd_id=159&prv_id=189&pdf_id=68" REL="nofollow"> AAMC website</a><br/>The number of applications per derm spot is 1.16 whereas for general surgery it is 1.45<br/><br/>My guess is that this is the result of self selection. “Demand for general surgery residencies is at an ALL TIME HIGH. If you go by number of applicants per position, then gen surg is harder to get into than every single specialty out there, including derm, rads, rad onc, etc.”

He’s right. I didn’t believe it either so I looked it up on the
AAMC website
The number of applications per derm spot is 1.16 whereas for general surgery it is 1.45

My guess is that this is the result of self selection.

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