1) An internal medicine physician opened up a retail store selling preventive services.
My take: An innovate way to market primary care knowledge. Let’s see if the public appropriately values it for this model to be successful.
2) Resident work-hour caps seem to be adversely affecting the quality of graduating surgeons.
My take: Restricting resident hours impacts specialties in different ways.
In internal medicine, this results in increased hand-offs between doctors which negatively affects continuity of care and increases the frequency of medical errors from miscommunication. However, I would hypothesize that there isn’t a significant impact on internists’ training.
Surgeons and proceduralists need to hone their hand-eye skills, and that only comes with practice and experience. Restricting their hours, and subsequently the number of surgeries they can perform, possibly may have bigger repercussions.
I would be more concerned about an inexperienced surgeon who didn’t operate enough than an internist who wasn’t as versed in continuity of care.
Rather than a blunt rule applying to all residents, perhaps a more nuanced application of restricting surgeon and proceduralist work-hours needs to be considered.
3) The backlash against female physicians spreads to the UK in a BMJ article.
My take: The concern seems to be the influx of part-time physicians, who tend to be women. The cost of training a doctor remains the same, regardless of how much they work. Thus, the growing trend of part-time physicians may not be the wisest allocation of medical training resources.
However, changing this trend would require a “revolution in the attitude of society towards childcare and who has the responsibility for childcare.”
Is it realistic to expect that?
Related posts:
- Restricting resident work hours leads to a shortage of surgeons
- Surgeons don’t receive enough training when resident work-hours are capped
- Restricting resident work hours forces doctors to lie, and other unintended consequences of the 80-hour work week
- The steep price of restricting resident work-hours
- How work-hour restrictions harms resident surgeon training
- An incredible surgery, but would future surgeons be able to accomplish the same feat?
- Doctors lose a part of their training when resident work-hours are capped
{ 2 comments }
other options to improve surgical training:(1) more and better sim labs, (2) less scutwork.
Re #2 Kevin — having been on the wrong end of a 70-hour day the question is really what’s the trade off? If the surgeons/ internists are graduating with less experience what is the benefit? We all know the answer is fewer resident errors (which I presume equates to fewer deaths). And, it BS that procedure errors are what kills. The original studies in long-work day errors where done by having the residents diagnose MI’s on ECG’s. The internists are just as if not more likely to do harm.
One day I saw show where a reporter asked an ER doc “did you save a life today?”, he thought for a second then responded “No, but I didn’t kill anyone either”. I know it’s harsh but that’s the reality.
We regularly measure the benefit of drugs and procedures by cost per life-year saved so do the same for resident training. Whatever the program is, create a mandate that it can’t have an additional death rate of more than 3.4 per million (6-sigma level)? Involve the epidemiologists and statisticians and do it properly. How many errors are allowable before you control the hours? Finally, in this era of full disclosure, do you stand to benefit by having longer resident hours? I don’t.
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