I'm going to agree with Church Lady on this one. My life does not revolve around the hospital and my happiness is not based based solely upon patient outcome. If that were the case, I would live in some medical utopia where patients would take a vested interest in their healthcare, the nurses would do a better job of following orders, and malpractice attorneys wouldn't force us to order unnecessary tests.
As far as the "real world" argument goes, I don't know of many attendings that work 80 hours a week in a hospital. I still wonder if this world really exists.
The "real world" exists outside academia. It's called "private practice," and it's where I and my colleagues work.
Of the private practice docs I know, none of the primary care physicians come close to working 80 hours in a week. And among the surgeons, more cases (more hours) are taken only make more money or to establish a reputation.
Well, Half MD, you will be in for a rude awakening. You will come out of training feeling wholly unprepared. Or worse, you'll come out feeling you do know everything, and won't know to ask for help/direction.
I've worked in 3 places in private practice. I do call every other week currently. It is true that some weeks I "only" work 70 hours, but most weeks I work 80-90 hours. You also have to remember that even if you don't work 80 hours, there will be many times you will be up all night then have to take care of patients all day.
I haven't been out of residence THAT long (10 years) but am appalled at some of the arbitrary changes.
I wish you well
Aren't doctors supposed to base their opinions on real evidence? I read the opinions of one doctor after another who adamently believe that the only way to adequately train new physicians is to give them more and more experience on the wards. I have never seen any evidence anywhere to support such an opinion. If anything, I believe that we become good doctors despite the grueling hours of residency, not because of them. Maybe you do learn a little bit by doing, but you learn much more by learning.
Actually, we have decades of good, albeit retrospective data about how well we do training physicians the old fashioned way -- that data being the physicians that have been through the system and have subsequently gone on to practice. What I have yet to see is data that demonstrates the new method is comparable; as I alluded to in my post, there is evidence to the contrary.
To put it another way, the people who brought our schoolchildren "new math" and "whole language" have been given free reign to change medical education specifically without the kind of data you are requesting.
True the hours that are scheduled are much less than 80/week, but then put in the night call, covering the entire weekend and not getting home due to one or more bad patients that just will not stablize and the hours add up. I am still looking for the 40 hour per week that the paycheck states I work, but have not found it. The trick is to schedule all the emergencies and have every patient respond as predicted so standard orders could be used. I am also still looking for the standard patient. Good luck with your future Half MD, ER or Doc in the Box may be better choice for you.
Great use of the pics in your post. Very entertaining!
Why don't surgery residency programs just tack on more years so that residents can get equivalent number of procedures under their belts as the old timers?
Driving under the influence of sleep deprivation is against the law in some places. Isn't surgery more difficult than driving?
The dumbing down of this country crosses all dynamics.
The residents of today are nowhere near what they were 10 years back.
Loved your post, I might put it up in the lounge tomorrow.
I agree with Agrrav Docsurg. Surgerizing skill needs surgerizing experience and competent cross covering on surgical pts requires familiarity with that case. I think the Docs that treat this profession as "only a job," and not anything more than that is contributing to the errosion of respect for our field by the general public.
Very apt. Your photo dialogues are a scream but it's too deadly serious for me to really enjoy a laugh. Maybe I should have my appendix out now, so it doesn't go bad on a weekend or holiday some day in the brave new world.
Oh BTW, I am a family doc, not a surgeon. I take my own call 26 days a month (it's all about continuity!), work about 40hrs/week NOt including call, and consider myself PART-time. The reward, Half MD, is in doing it well, not (or not only) in the outcome.
As usual, as surgical residents, we get stuck between the proverbial rock and the hard place. On the one hand we have these ridiculous rules handed down by the sorts of committees that gave us the utterly undiscernable "ACGME Core Competencies." We are told that we have to adhere to duty hour rules whether they make sense or not, and we have all of these anonymous whistle-blower tools to tattle on our programs if they don't. Of course if we do tattle on the program it gets de-accredited and guess who gets to go look for another job because they need to graduate from an accredited program?On the other hand we get to hear the attendings whine all day long about how we are a wimpy generation of surgeons because "back in the days of giants..." Of course this is all coming from the "My job is to fix God's mistakes" curmudgeon generation who gave us 90,000 unnecessary patient deaths each year and somehow seems to think that operating after being up so long that one is functioning at the level of being legally intoxicated is somehow a "character building" exercise. They somehow persist with this myth that they have never EVER had to sign out a patient.
As always, we do what we always have done: we keep our heads down, take care of patients even if it means fudging our hours numbers to make the reports look pretty (or any number of rule-skirting techniques employed by programs -- e.g. 'home call'), take the crap dished by the attendings, and promise ourselves we aren't going to turn out like our parents.
As usual, as surgical residents, we get stuck between the proverbial rock and the hard place. On the one hand we have these ridiculous rules handed down by the sorts of committees that gave us the utterly undiscernable "ACGME Core Competencies." We are told that we have to adhere to duty hour rules whether they make sense or not, and we have all of these anonymous whistle-blower tools to tattle on our programs if they don't. Of course if we do tattle on the program it gets de-accredited and guess who gets to go look for another job because they need to graduate from an accredited program?On the other hand we get to hear the attendings whine all day long about how we are a wimpy generation of surgeons because "back in the days of giants..." Of course this is all coming from the "My job is to fix God's mistakes" curmudgeon generation who gave us 90,000 unnecessary patient deaths each year and somehow seems to think that operating after being up so long that one is functioning at the level of being legally intoxicated is somehow a "character building" exercise. They somehow persist with this myth that they have never EVER had to sign out a patient.
As always, we do what we always have done: we keep our heads down, take care of patients even if it means fudging our hours numbers to make the reports look pretty (or any number of rule-skirting techniques employed by programs -- e.g. 'home call'), take the crap dished by the attendings, and promise ourselves we aren't going to turn out like our parents.
As usual, as surgical residents, we get stuck between the proverbial rock and the hard place. On the one hand we have these ridiculous rules handed down by the sorts of committees that gave us the utterly undiscernable "ACGME Core Competencies." We are told that we have to adhere to duty hour rules whether they make sense or not, and we have all of these anonymous whistle-blower tools to tattle on our programs if they don't. Of course if we do tattle on the program it gets de-accredited and guess who gets to go look for another job because they need to graduate from an accredited program?On the other hand we get to hear the attendings whine all day long about how we are a wimpy generation of surgeons because "back in the days of giants..." Of course this is all coming from the "My job is to fix God's mistakes" curmudgeon generation who gave us 90,000 unnecessary patient deaths each year and somehow seems to think that operating after being up so long that one is functioning at the level of being legally intoxicated is somehow a "character building" exercise. They somehow persist with this myth that they have never EVER had to sign out a patient.
As always, we do what we always have done: we keep our heads down, take care of patients even if it means fudging our hours numbers to make the reports look pretty (or any number of rule-skirting techniques employed by programs -- e.g. 'home call'), take the crap dished by the attendings, and promise ourselves we aren't going to turn out like our parents.
That's your life.
Hey AD =)
I noticed your rant on how the artificial 80 hour work week restrictions have hurt us. I think the folks in charge have no clue how much that is hurting our education.
I wanted to bring to your attention one website that has made a difference in my ABSITE preparation. One thing I have found to be valuable is a reading course they have with Sabiston's that forces me to read through the entire book in a piecemeal fashion. Their reading course in surgery also has weekly exams. I think it's a pretty neat offering. Just my two cents.
Oh, the website is http://www.clinicalreview.com. Let me know what you think!
Nicki
PGY4
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