How resident work-hour restrictions is affecting housestaff:
The conversation is shifting. Traditional hierarchical patient management is giving way to the need for “scut management” as work hours, thrown in amongst teaching sessions, draw short. Divide-and-conquer. No time for supervision. Hurry up! We’ve got to get done!
These restrictions have to be accompanied by a sizable bump in ancillary staff to reduce scut. Filling out paperwork and drawing blood for instance. Housestaff should not be glorified secretaries or phlebotomists, and instead focus on managing the patient.
This probably isn’t happening, especially in financially-strapped inner city hospitals. What will happen is that medical students will start applying to wealthier hospitals that have appropriate ancillary support.
Less scutwork will maximize learning. Every minute counts when the you’re on the clock.
Related posts:
- Resident work hour restrictions
- Do physician assistants need work-hour restrictions too?
- Work-hour restrictions in surgery?
- Poll: Are the Institute of Medicine’s recommended restrictions on residents’ work hours good for medicine?
- Are resident work-hour restrictions doing a disservice?
- How work-hour restrictions harms resident surgeon training
- Who will pick up the slack from resident work-hour restrictions?
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{ 4 comments }
Scut Management = Student Responsibilities.
I understand the importance of being on the floor, in the wards, and in the OR, believe me. But filling out discharge orders, chasing down blood culture results from other hospitals, and running down to the Radiology Crypt to harass a poor resident into giving me a preliminary read on an abdominal CT seem to have occupied more of my time as a medical student than anything else. All the while paying 20,000 or more a year for an hour or two of face time with attendings who then are darn near impossible to chase down for letters of recommendation and barely remember you when they do.
I don’t know what it was like back in the day, but now we are told, flat out, by many residents that our grades are based on the amount of scutwork we handle. This is not true for all, by any means. But the indentured servitude does get old.
“All the while paying 20,000 or more a year for an hour or two of face time with attendings who then are darn near impossible to chase down for letters of recommendation and barely remember you when they do.”
indiancowboy, you’re right to be upset, but don’t blame the attendings. They have to cover their salaries with their clinical productivity. Blame the deans and department chairmen who your $20,000 is going to for ripping you off.
Technology has definitely made some positive changes in terms of scut work; in med school I was always trying to track down x-rays, CTs, etc; now we just pull up the digital images on the computer. Lab results generally appear on the computer fairly quickly. Unfortunately, there is some very unnecessary scut work at my program. Making follow-up appointments for patients without private insurance can easily take hours. Trying to get records from other health care facilities also can take an entire afternoon. Putting in IVs and drawing stat labs are also time wasters. My favorite scut assignment of all is transporting stat specimens to the lab, because the hospital decided to stop having employees to do that. None of these things require an MD or even a college degree. If the hospital would pay for more administrative staff we would have more high quality learning time.
“Trying to get records from other health care facilities also can take an entire afternoon”
Family Medicine REsident, that was my least favorite type of scut during residency.
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