Comments on: The impact of regulating residents’ work hours http://www.kevinmd.com/blog/2006/12/impact-of-regulating-residents-work.html Tue, 14 Feb 2012 21:09:00 +0000 hourly 1 By: Anonymoushttp://www.kevinmd.com/blog/2006/12/impact-of-regulating-residents-work.html#comment-87946 Anonymous Thu, 06 Nov 2008 01:56:00 +0000 http://clients.emmense.com/kevinmd/2006/12/the-impact-of-regulating-residents-work-hours.html#comment-87946 Finally, this is getting to be enough. A significant number of older docs on this forum continue to harp on their younger colleagues. In my experience as a chief surgical resident, the "worst" surgeons I've seen are mostly the older docs who operate rarely, and are not up to date on the appropriate medical management of patients. As a chief resident, I have had to constantly "de-privatize" patient in our large academic medical center (with a large number of private attendings who have admitting privilages). These folks keep griping about the resident hours, while their own post-op and medical care is substandard and inappropriate (DVT prophylaxis, post-op pulmonary edema issues, inaapropriate overloading of CHF patients, and overall outdated and innaproprite "clinical judgment"). Overall, when my frineds and family ask me for doc recs, i usually say "just do not get anyone >10yrs out from residency unless you know that they keep up with current evidence and guidelines. Finally, this is getting to be enough. A significant number of older docs on this forum continue to harp on their younger colleagues. In my experience as a chief surgical resident, the "worst" surgeons I've seen are mostly the older docs who operate rarely, and are not up to date on the appropriate medical management of patients. As a chief resident, I have had to constantly "de-privatize" patient in our large academic medical center (with a large number of private attendings who have admitting privilages). These folks keep griping about the resident hours, while their own post-op and medical care is substandard and inappropriate (DVT prophylaxis, post-op pulmonary edema issues, inaapropriate overloading of CHF patients, and overall outdated and innaproprite "clinical judgment"). Overall, when my frineds and family ask me for doc recs, i usually say "just do not get anyone >10yrs out from residency unless you know that they keep up with current evidence and guidelines.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/12/impact-of-regulating-residents-work.html#comment-85744 Anonymous Fri, 23 May 2008 00:08:00 +0000 http://clients.emmense.com/kevinmd/2006/12/the-impact-of-regulating-residents-work-hours.html#comment-85744 "I trained at Charity in the 70's and some of most vivid learning experiences were in the long hours when you decide whether the patients safety and comfort are more important than your own rest."<br/><br/>You know it would be one thing if that were a rarity, but since it's not, there is a problem with the system. Most people went to medical school to be doctors not martyrs. Don't force your desire to purge your percieved sins on the rest of us. And frankily, you aren't helping patients with the machismo.<br/><br/>"I later was the only ob in a small town and I can assure you that knowing your limitations and capabilities are best learned early. If you cant take the stress of fatigue, take another job."<br/><br/>You gonna pay my loans off? “I trained at Charity in the 70′s and some of most vivid learning experiences were in the long hours when you decide whether the patients safety and comfort are more important than your own rest.”

You know it would be one thing if that were a rarity, but since it’s not, there is a problem with the system. Most people went to medical school to be doctors not martyrs. Don’t force your desire to purge your percieved sins on the rest of us. And frankily, you aren’t helping patients with the machismo.

“I later was the only ob in a small town and I can assure you that knowing your limitations and capabilities are best learned early. If you cant take the stress of fatigue, take another job.”

You gonna pay my loans off?

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/12/impact-of-regulating-residents-work.html#comment-78782 Anonymous Thu, 09 Aug 2007 18:17:00 +0000 http://clients.emmense.com/kevinmd/2006/12/the-impact-of-regulating-residents-work-hours.html#comment-78782 It is just as irresponsible for residents/interns to perform unnecessary 30-hour shifts of patient care as it would be for them to come to work drunk. Even if studies don't always show a reduction in medical errors with work hour restrictions, they also don't show an increase in errors. At least <a HREF="http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=16125616&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus" REL="nofollow">one study shows that objectively, case volume is NOT affected by work hour restriction</a>. <a HREF="http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17403816&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus" REL="nofollow">Here's another study.</a> So if there is no real benefit in working longer hours and having burned-out, chronically sleep deprived residents, why put anyone through it? Why not allow them to be good parents, husbands, wives, students, etc while learning to be doctors, or at least allow them to exercise and maintain a healthy lifestyle and positive outlook? Yes, they will have long hours and call nights once they are in the "real world", but is this good justification for them to abuse their health right now?<br/>Do you think there is a problem with nurses working only 12-hour shifts? There are <a HTTP://WWW.NCBI.NLM.NIH.GOV/SITES/ENTREZ?DB=PUBMED&CMD=SHOWDETAILVIEW&TERMTOSEARCH=15318582&ORDINALPOS=1&ITOOL=ENTREZSYSTEM2.PENTREZ.PUBMED.PUBMED_RESULTSPANEL.PUBMED_RVABSTRACTPLUS HREF="" REL="nofollow">studies that show that longer nursing shifts have a deleterious effect on patient care.</a><br/>Should airline pilots "put the passengers first" and fly 36 hours in a row with no sleep? Would that really be "putting the passengers first"?<br/>The older doctors are in the mindset of "I did it, so they should do it too", as if it is some sort of hazing ritual. Hazing isn't a good enough reason to make decisions this important. It is just as irresponsible for residents/interns to perform unnecessary 30-hour shifts of patient care as it would be for them to come to work drunk. Even if studies don’t always show a reduction in medical errors with work hour restrictions, they also don’t show an increase in errors. At least one study shows that objectively, case volume is NOT affected by work hour restriction. Here’s another study. So if there is no real benefit in working longer hours and having burned-out, chronically sleep deprived residents, why put anyone through it? Why not allow them to be good parents, husbands, wives, students, etc while learning to be doctors, or at least allow them to exercise and maintain a healthy lifestyle and positive outlook? Yes, they will have long hours and call nights once they are in the “real world”, but is this good justification for them to abuse their health right now?
Do you think there is a problem with nurses working only 12-hour shifts? There are studies that show that longer nursing shifts have a deleterious effect on patient care.
Should airline pilots “put the passengers first” and fly 36 hours in a row with no sleep? Would that really be “putting the passengers first”?
The older doctors are in the mindset of “I did it, so they should do it too”, as if it is some sort of hazing ritual. Hazing isn’t a good enough reason to make decisions this important.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/12/impact-of-regulating-residents-work.html#comment-69813 Anonymous Fri, 22 Dec 2006 03:33:00 +0000 http://clients.emmense.com/kevinmd/2006/12/the-impact-of-regulating-residents-work-hours.html#comment-69813 cdclled:<br/>Let's get this this straight. If you are a resident than you are in a glorified APPRENTICESHIP. You are not an attending. You are certainly not qualified to take care of patient's on your own (at least early on). You can call it a conspiracy (which I agree to an extent it is), but the simple fact is without the residency certificate you couldn't practice in your (sub)specialty and without an internship you can't practice anything at all. You knew very well beforehand that the hours were lousy and compensation per/hour not great. The idea is to get paid a livable wage while you are learning how to become an independent competent doctor. Certainly it could be more. If you didn't already know medicare pays the hospitals over 100K per resident per year. If you would have cleaned toilets just because it was an attending wage then very simply you are in the wrong profession. And please cut the comparison to Burger King workers. You residency is a set period of time in which you are making at a minimum of 30-35K per year. After the residency ends you can increase that by a factor of 5-10. The level of "scut" is much less than when I was an intern and frankly the fact is you will be doing "scutwork" as an attending private doctor...get used to it. The fact is you are a resident.... an apprentice in a field with awesome professional responsibility. Not an hourly or shift worker. Trust me your attitude makes me wonder what will happen when I need regular care by doctors. cdclled:
Let’s get this this straight. If you are a resident than you are in a glorified APPRENTICESHIP. You are not an attending. You are certainly not qualified to take care of patient’s on your own (at least early on). You can call it a conspiracy (which I agree to an extent it is), but the simple fact is without the residency certificate you couldn’t practice in your (sub)specialty and without an internship you can’t practice anything at all. You knew very well beforehand that the hours were lousy and compensation per/hour not great. The idea is to get paid a livable wage while you are learning how to become an independent competent doctor. Certainly it could be more. If you didn’t already know medicare pays the hospitals over 100K per resident per year. If you would have cleaned toilets just because it was an attending wage then very simply you are in the wrong profession. And please cut the comparison to Burger King workers. You residency is a set period of time in which you are making at a minimum of 30-35K per year. After the residency ends you can increase that by a factor of 5-10. The level of “scut” is much less than when I was an intern and frankly the fact is you will be doing “scutwork” as an attending private doctor…get used to it. The fact is you are a resident…. an apprentice in a field with awesome professional responsibility. Not an hourly or shift worker. Trust me your attitude makes me wonder what will happen when I need regular care by doctors.

]]> By: cdclledhttp://www.kevinmd.com/blog/2006/12/impact-of-regulating-residents-work.html#comment-69810 cdclled Thu, 21 Dec 2006 23:56:00 +0000 http://clients.emmense.com/kevinmd/2006/12/the-impact-of-regulating-residents-work-hours.html#comment-69810 Anon 1:35,<br/><br/>I think the complaints stem more from the issue of compensation than working long hours. I would gladly work 120 hrs/week cleaning hospital bathrooms if you'll pay me my attending's salary. It isn't the amount or menial nature of scut that presents the problem, it's the fact that residents already earn less than minimum wage, and unlike hourly employees at Burger King who can increase their salary by working more hours, residents venture even further into sub-minimum wage territory with increasing hours. Anon 1:35,

I think the complaints stem more from the issue of compensation than working long hours. I would gladly work 120 hrs/week cleaning hospital bathrooms if you’ll pay me my attending’s salary. It isn’t the amount or menial nature of scut that presents the problem, it’s the fact that residents already earn less than minimum wage, and unlike hourly employees at Burger King who can increase their salary by working more hours, residents venture even further into sub-minimum wage territory with increasing hours.

]]> By: Gasmanhttp://www.kevinmd.com/blog/2006/12/impact-of-regulating-residents-work.html#comment-69804 Gasman Thu, 21 Dec 2006 20:29:00 +0000 http://clients.emmense.com/kevinmd/2006/12/the-impact-of-regulating-residents-work-hours.html#comment-69804 I wonder what residents are calling scut work these days. Much of what I did for patient care as a student and resident could have fallen under the rubric of 'scut' no longer exists for these trainees to do. <br/>After 5 pm (3 at the VA) all phlebotomy was student or resident. Need to get your patient to x-ray, well start pushing the bed. 12 lead EKGs were obtained by getting the machine from the Unit, and putting the electrodes on the patient's chest. I placed foleys, obtained blood cultures, put needles into just about every place in the body immaginable. Hematocrits were spun on the cetrifuge, urines were spun, stained and examined under the microscope, I could do a Wright stain or H/E in ten minutes for the blood smear or touch prep. Virtually all of this was labeled as scut by many then. Residents now do none of these tasks, and what's more, they will never be able to do anything for themselves/their patients without continuous handholding from the support staff of their hospital. The only scut that remains is documentation; back in the old days (oh, say 1990) we did all that with ball point pens on paper; same thing they do with their PDAs and rows of terminals at the nursing stations now. <br/>It ain't scut, it's patient care. And the peons today are doing a heck of a lot less of it than just a decade ago. I wonder what residents are calling scut work these days. Much of what I did for patient care as a student and resident could have fallen under the rubric of ‘scut’ no longer exists for these trainees to do.
After 5 pm (3 at the VA) all phlebotomy was student or resident. Need to get your patient to x-ray, well start pushing the bed. 12 lead EKGs were obtained by getting the machine from the Unit, and putting the electrodes on the patient’s chest. I placed foleys, obtained blood cultures, put needles into just about every place in the body immaginable. Hematocrits were spun on the cetrifuge, urines were spun, stained and examined under the microscope, I could do a Wright stain or H/E in ten minutes for the blood smear or touch prep. Virtually all of this was labeled as scut by many then. Residents now do none of these tasks, and what’s more, they will never be able to do anything for themselves/their patients without continuous handholding from the support staff of their hospital. The only scut that remains is documentation; back in the old days (oh, say 1990) we did all that with ball point pens on paper; same thing they do with their PDAs and rows of terminals at the nursing stations now.
It ain’t scut, it’s patient care. And the peons today are doing a heck of a lot less of it than just a decade ago.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/12/impact-of-regulating-residents-work.html#comment-69795 Anonymous Thu, 21 Dec 2006 18:35:00 +0000 http://clients.emmense.com/kevinmd/2006/12/the-impact-of-regulating-residents-work-hours.html#comment-69795 It is obvious the naysayers on this thread have never worked in private practice. This is the truth, unless you are an ER doc, hospitalist, or in a "lifestyle" field you will be expected to take overnight call...period. That's the way it is. The options are for patient's/ERdocs needing night services or c/s are A: On call doc B: NO DOC....PERIOD. You will be expected at times to work an inordinate number of hours as an attending. There is no RRC to hold your hand in the real world...period. This is not arrogance or garbage thinking, it is the way it is and to start talking about "shiftwork" for all fields of medicine to correct the present hours issue means the writer has no grasp of economics and the fact that medicare/government payers are actively trying to cut spending wherever possible. "Scutwork" as the anon resident (I assume) derides is part of every private attending's day to day life. Either accept it or go do something else....period. Your future patient's will thank you. It is obvious the naysayers on this thread have never worked in private practice. This is the truth, unless you are an ER doc, hospitalist, or in a “lifestyle” field you will be expected to take overnight call…period. That’s the way it is. The options are for patient’s/ERdocs needing night services or c/s are A: On call doc B: NO DOC….PERIOD. You will be expected at times to work an inordinate number of hours as an attending. There is no RRC to hold your hand in the real world…period. This is not arrogance or garbage thinking, it is the way it is and to start talking about “shiftwork” for all fields of medicine to correct the present hours issue means the writer has no grasp of economics and the fact that medicare/government payers are actively trying to cut spending wherever possible. “Scutwork” as the anon resident (I assume) derides is part of every private attending’s day to day life. Either accept it or go do something else….period. Your future patient’s will thank you.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/12/impact-of-regulating-residents-work.html#comment-69771 Anonymous Thu, 21 Dec 2006 12:22:00 +0000 http://clients.emmense.com/kevinmd/2006/12/the-impact-of-regulating-residents-work-hours.html#comment-69771 Had a 2-1/2 year course of treatment from a non-profit hospital's university-affiliated surgical group several years back. Found the residents to be terrific -- far better bedside manners than even the nurses. Also saw after the fact that the notes in my record from the residents were very thorough. Since I have fewer complimentary things to say about the attending, I'll say nothing on that subject. He gave support to a lot of unpleasant stereotypes about surgeons. Had a 2-1/2 year course of treatment from a non-profit hospital’s university-affiliated surgical group several years back. Found the residents to be terrific — far better bedside manners than even the nurses. Also saw after the fact that the notes in my record from the residents were very thorough. Since I have fewer complimentary things to say about the attending, I’ll say nothing on that subject. He gave support to a lot of unpleasant stereotypes about surgeons.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/12/impact-of-regulating-residents-work.html#comment-69751 Anonymous Wed, 20 Dec 2006 18:55:00 +0000 http://clients.emmense.com/kevinmd/2006/12/the-impact-of-regulating-residents-work-hours.html#comment-69751 Quit whining and get back to work. Learn to tie a knot before showing up in the OR and maybe read about the case prior. Some of the very basics that todays residents just flat out ignore... Quit whining and get back to work. Learn to tie a knot before showing up in the OR and maybe read about the case prior. Some of the very basics that todays residents just flat out ignore…

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/12/impact-of-regulating-residents-work.html#comment-69749 Anonymous Wed, 20 Dec 2006 18:19:00 +0000 http://clients.emmense.com/kevinmd/2006/12/the-impact-of-regulating-residents-work-hours.html#comment-69749 "I've got news for you. That "scutwork" is also what you will be doing in private practice (unless you are a university attending..."<br/><br/><br/><br/>So let me get this straight.. You think residents should spend up to 120 hours a week in the hospital just so they can learn how to do scutwork and be "prepared" for the outside world? <br/><br/>What kind of garbage is that? You freely admit that there is zero educational training in working those exhausting schedules, so your comeback is to say "yeah its not educational but its the real world scut so they should have to deal with it?" Please tell me you are joking. Thats the most pathetic argument for longer work hours that I've ever heard of.<br/><br/>And again you ignore the impact on patients. I guess you do think its OK for a LEGALLY DRUNK resident to attend to a crashing patient in the ICU? “I’ve got news for you. That “scutwork” is also what you will be doing in private practice (unless you are a university attending…”

So let me get this straight.. You think residents should spend up to 120 hours a week in the hospital just so they can learn how to do scutwork and be “prepared” for the outside world?

What kind of garbage is that? You freely admit that there is zero educational training in working those exhausting schedules, so your comeback is to say “yeah its not educational but its the real world scut so they should have to deal with it?” Please tell me you are joking. Thats the most pathetic argument for longer work hours that I’ve ever heard of.

And again you ignore the impact on patients. I guess you do think its OK for a LEGALLY DRUNK resident to attend to a crashing patient in the ICU?

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