Saturday, January 5, 2013

Residency Blues

Last month, JACS published results from a national web-based survey completed by general surgery residents.  The findings paint a bleak picture of overall morale:


A total of 464 completed surveys were analyzed. Overall, 75% of residents expressed dissatisfaction with the new duty hour limitation. PGY II to V residents reported a higher level of dissatisfaction compared with PGY I residents (87% vs 54%, p < 0.01). Eighty-nine percent of PGY II to V residents responded that there has been a shift of responsibilities from the PGY I class to PGY II to V residents, with 73% reporting increased fatigue as a result. Seventy-five percent of PGY I and 94% of PGY II to V residents expressed concerns about the adverse impact of the restrictions on the education of PGY I residents (p < 0.01). Residents at all PGY training levels reported encountering problems due to inadequate sign-outs (PGY I, 59%; PGY II to V, 85%; p < 0.01). Sixty-two percent of PGY I residents and 54% of PGY II to V residents believed that the new 16-hour duty restriction contributes to inadequate sign-outs (p = NS). Most PGY II to V residents (86%) believe there is a decreased level of patient ownership due to the work hour restrictions.
(emphases added by me)
The first thing to point out is that surgical interns are not allowed to work more than 16 consecutive hours.  Because they might get sleepy.  And those bedhead hairdos on morning rounds were just too distracting for well coiffed Attendings.  Or something.

So we have unsurprising findings that residents being sent home from apprenticeship based on arbitrary time limits are concerned about both their own education (less time in hospital/OR equals decrease in comfort level with complex surgical issues) and patient safety (compromised patient-info sign outs).  That's fantastic.  I can't wait when I'm old and broken down  and these folks will be taking care of me at 3AM.     


Anonymous said...

Orthopedic PGY-1 here. I am glad that these things are being discussed in the literature and it is something that is discussed among residents more than people realize. While I know that I don't have a basis for comparison, and while it is pretty nice to be ''protected," I am becoming more apprehensive about what is going to happen to me next year as a PGY-2.

The only saving grace to some of this, which isn't much of one, is that residents recognize the issues inherent with this and find ways around the rules... Usually by flat out lying. I can assure you that at most places, unless you have one of the stupid clock in/clock out systems, people just stay around and do what they have to do to work or go to the OR. While no resident appreciates hearing the 'back in my day' talk from attendings, works like the one you show here prove that we know the profession we chose isn't a 9-5 shift work job.

Anonymous said...

Vascular pgy-1 categorical here. I think the 16 hour work day is a mixed bag

The wide institution of PA night float ensures we're actually in the hospital more during the day when the majority of cases are going

less under-supervised, middle of the night, trial by fire type learning

we still have pgy2-5+ to be exposed to that

It doesn't really make sense that we are the most protected residents as we have the least decision making responsibility of anyone on the team

no post call days

fewer emergency cases, that we are only covering because it's in the middle of the night

again we have pgy2-5

Anyway, in a straight vote, I'm sure most pgy-1s would opt for an 80 hour week with no stupid restrictions on work day-hours, but I don't think it will make much difference in the long term. I guess the slippery slope argument isn't going away though. If they keep cutting our hours back, we'll never be trained.

Frank Drackman said...

Thats the problem with you Surgeons, wanting, nee, volunteering to work more and more hours for less and less dough, and you get less respect than Ronny Dangerfield at his best.
I trained in the bad old days, and you know who we admired(OK during my one year of actual clinical medicine)the Resident who could work an entire call day with Zero Admissions, no matter how "Sick" they claimed to be,

Frank "The best admissions are the ones you don't" Drackman