Wednesday, December 3, 2008

Half time = Half trained

The kinder and more gentle days of residency are upon us. Residents are limited to 80 hours a week. This is a big change. The term resident came from the fact that doctors in training resided in the hospital. You litterally ate, breathed and lived medicine. This was the way to cram as much training and experience as possible into the years you spent after medical school. Residencies got longer and longer as there was more to know. In surgery, the saying was that if you were on call every other night, you missed half the cases and had half the experience. This came from the fact that the days were filled with the routine cases but the emergencies that came in while on call prepared you to handle anything. Now we have surgery residents checking out like they work in a factory. "I reached my limit and its time to go!" In many cases the hour limits have decreased the experience by a third to a half.

Here is one of the problems. Is a surgeon who has only 2/3 of the experience handling emergencies as good as one who has done more? Should we increase the length of residencies? Surgery is already 5 to 7 years. Neurosurgery can be 7. This does not count fellowships. All this is after 4 years of college and 4 of medical school.

Was I tired in residency? You bet, I learned to catnap, eat standing and to follow the rules of "The House of God". See a bed, lay in it. See food, eat it. See a chair, sit in it. When I finished residency it was better but I still had the long hours because I was supervising residents.

Here is another thing. Out of residency, you cant have your beeper go off and tell the ER that "no, I cant help with that emergency, I have already worked my hours." "Sorry that the baby has decels and a c-section is needed, Ive reached 80." Residency prepares you for what its like in the real word. There are no work hour restrictions in the real world.

I tried to expain our work ethic to a friend who is an attorney and explained that you go home when the work is done and get called in when there is more work to do. We base things on the job to do. You go home when the patients are stable. He didn't understand, he gets paid by the billable hours, the longer something takes, the more money he makes. It is to his advantage to drag things on as long as possible. He can go home anytime he wants. It not like people are dying!


SeaSpray said...

I've wondered about the reduced hours. Surely the powers that be must have reasoned all this out?

Wasn't it intended to reduce the chance of medical errors as a result from being sleep deprived residents? Paradoxically.. it seems the very thing they intended to prevent harm may in the long run cause harm because of lack of experience.??

Also...isn't there an issue with if the doctor wasn't pushed to the limits in residency...then how will he handle the stresses in practice?

I give you and your colleagues so much credit for all you have sacrificed and achieved.

I don't think said "80 hour" residents could handle your recent on call holiday weekend?

I guess your surgical residencies were like one real long surgical boot camp where you learn everything and get toughened up along the way.

I just hope they find a way to compensate for the missed time.

Lawyers do seem to have it better with billable hours. They must have their stresses too. Then again... I am thinking that docs love what they do and that is important too.

I have read so much in the med blogasphere and obviously you make good salaries and if you specialize you earn more, but I think it is so wrong that you have to be so concerned with lawsuits 24/7, reduced reimbursements or have to appeal for insurance payments that are rightfully yours. And that you have less time for your patients because you have to move them through because of how the system is set up... and I could go on and you know it all anyway... but here you work with people to restore them back to good health or save lives and it is such a noble profession... medicine.

I gave a copy of your holiday Prozac beeper post to my urologist today because I figured being a surgeon he would certainly appreciate it. I probably shouldn't give him stuff like that as he has never commented on anything funny and I imagine my patient file is voluminous enough due to my frequent flier status at hospital and office over the last few years. Still..I think this one was so good...I am sure he must've gotten a laugh out of it. :)

At dinner tonight...I was telling a friend about how involved medicine is with regulations and everything needing to be documented electronically in all facets of care and how that hinders actual hands on patient care. I then told her about the nurses comment and how it brought a tear to your eye. She busted out laughing!

That was excellent. :)

SeaSpray said...
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SeaSpray said...
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SeaSpray said...

Hey... I hope the previous comments weren't offensive to you or anyone else that may have read them. My apologies if they were. :)

Lots of people in all walks of life have strong personalities. I just think Surgeons have to be tough for their line of work and it can cross over into interactions outside the OR too. And I in no way meant to infer that they lack tenderness or compassion... if I did.

This post was very interesting.