unfortunately, that line is pretty blurry. when i was in the ICU as a resident, managing 16 very complicated and critically ill patients and carrying the code beeper for the hospital for 36 hours straight, no sleep, no rest, barely enough time to eat a snack or 2 during that shift, was i safe? guess it’s subject to debate.

I think you should separate the issues of residency from the career, as they are two competely different worlds.

You ended with this question->
"Are cash-strapped hospitals willing to spend the money to increase the size of their residency programs?"

To the best of my knowledge, hospitals have nothing to do with determining the size of a residency program. The size of a program is determined by the RRC and ACGME based on the ability for a hospital system to support the training requirements. The hospital recieves governmental support for each residency position. Therefore, the "cash-strapped" hospitals actually are subsidized for each resident.

JFS

Now, decades later, I realize that it is stupid and egocentric not to take off when sick. I have seen enough friends and colleagues literally work themselves to death. In each and every case, the patients who were acutely ill have someone else taking care of them within hours. A solo practitioner friend had a heart attack on morning rounds. The chief of staff had his patients reassigned to other doctors before he got to the CCU. In a rural community where I once practiced several specialties had one-doctor coverage. The primary care docs stepped and filled the gaps when the specialists were out of commission just fine. Transfer a few patients, put off some elective procedures . . . it works out.

You are not that critical. The world will go on without you. Take care of yourself. And take time off to go to the dentist during residency. In 30 years you’ll regret it if you don’t. Don’t neglect that the way I did. Don’t buy the bullshit.

I still work with the sniffles and colds, etc. I am in an office setting around people with generally good constitutional health. On those days, I will reschedule especially vulnerable patients.

But I will not work when I am miserable enough that my ability to attend to the patient is compromised. I don’t leave them on their own–I make arrangements where they need to be made but this suffering hero crap isn’t for the patients, it is for the doctors ego. I grew out of it.

If you die in a car wreck today, your patients will be fine.

Also, I am not going to stay up all day fighting to keep my eyes open if kept awake most of the night before whether by patients or a sick family member. Sure it costs me a lot of money to cancel the afternoon and take a nap but it is the fair thing to do for the patients.

As he began to feel sicker he had a nurse hang a bag of normal saline and give him some insulin, and he just stayed in the physician computer room while getting his bolus. All the while, he was the only physician in the ED, not counting the intern and me, the 4th year med student. Personally, I was just hoping nobody coded or needed an emergent procedure. I didn’t like how when I presented my cases to him he kept nodding off, finding it difficult to pay attention.

The fact is, this was unsafe. Luckily, nothing bad happened, and he didn’t need to do any procedures that night… god forbid he try a central line and drop a lung or worse. Point is, when you’re sick enough to compromise patient care, you need to call in reinforcements, whoever they are, and whatever it costs. Are an intern and a 4th year med student sufficient reinforcements? If you’re lucky, and I’m your med student. OK, I’m just kidding about the last part.

I am sick of people from corporations who have never had a significant responsibility in management having nothing to say except about how annoyed they get when someone else is ill in their midst. How rude of them.

I suppose if no one really counts on you for anything, your absence wouldn’t be missed. Who knows, it might even be relished.

But being on a team where others really do count on you to be there to work, where important things would not get done without you and where others’ effectiveness would be compromised, sometimes you have to decide that showing up is necessary even if you don’t feel well.

Explaining that to someone who has never had that kind of responsibility is difficult. You have to have done it to know it.

It is very difficult, not to mention expensive to call out when your job is structured that way. A doctor in solo practice doesn’t have someone to fill in when he is sick. He is fortunate to be able to get someone to cover for emergencies. When the doctor is out, the overhead still has to be paid, but there is no work done and billed and thus no income. When you run overhead figures over 60%, one or two days out will hurt the whole month. And it is very difficult to count the cost of lost goodwill from disappointed patients who are inconvenienced twice.

So in the twenty years since I started in medicine, I can recall only once when I called out sick. And I was pretty sick.

As for the poster Anonymous 8:38 P.M., you are so utterly without a clue and self-absorbed; for you, it is all about your “rights.”