Work-hour restrictions and poorly-trained surgeons

Heh, well, medicine and surgery have come a long way from the days when docs only had four antibiotics to choose from and the standard treatment for an MI was an aspirin and crossed-fingers. (I stole that from an attending who scoffs at his colleagues’ gripes regarding resident work-week restrictions.) There’s simply too much for any one person to know, and what was general then ain’t so general now. In any case, the hours-in-a-row thing is a red herring. At my not-to-be-named institution, the real consequence of the ACGME mandates on the surgery programs is reducing a surgery resident’s work week from 160 hours to 120 hours, and I really don’t know how they manage to hide those extra 40 hours from the auditors. The real solution, which I’m sure will be highly unpopular, is to simply lengthen residency training. We’re already doing it under the table by essentially requiring people to pursue fellowships, so why not make it official? The alternative, though, is simply to make amphetamines readily available and mandatory for residents, and then maybe it would be reasonable to go back to the bad old days.