Medstudent,
don't take any of my remarks personally (that's why I added the )
But, I will say this: adding another is total BS. I don't know what your loan situation is, but I am 140K in the hole and I only get 3 years of deferment. After that, the interest is adding on. Second, we (General Surgery Residents) we getting everything we needed, under the old system, in 5yrs. Why in the world we want to add another, when the easy and correct answer to do away with the work hr restrictions? It doesn't do anything to address the real problem. Namely, what will residents, who are trained under the new system, do when they are an attending and no longer fall under the work hr protection i.e. the can't go home post-call....they will be ill prepared to face the challenge of treating patients while sleep deprived. Under the old system, you were conditioned to handle it. Now, well... I think you guys are in for a real rude awakening (at least those in Gen Surgery, Gyn, Urology etc...where you have emergent operations and such). Lastly, adding another year just makes the road that much longer for those of us that want to pursue a fellowship. I am going to do Vascular Surgery (vs. Surgical Oncology...both 2 additional years) all total, making my post graduate years 8 (I took a year to do research).
Again, no hard feelings toward you....I just think the system is broke.

 

I appreciate your dedication Steve. I am dedicated to my work too, but I do believe that overworking does take a toll and is unnecessary. THe problem with the ACGME is their implementation of rules without studying effects of those rules. They say, here's your standard now follow it.

THey don't tell you how to or even try to help you understand how to follow that standard. The 80 hour work week is a good thing. Even the hard core do it or die Vascular surgeon at my hospital finally agreed. (WHen it first started, all he did was bitch about it.) What is needed is for someone who is not a doctor to do the scut. This is what wastes a lot of time. If it was not for scut and stupid rules then things could be done as well without all of the extra time at the hospital.

A couple of things come to mind. A secure link for me to the hospital mainframe saved me a lot of time because I could do my preoperative workup from my home. I could look up labs, H&P and demographics so I could call my patient's the night before their operation and discuss the anesthetic plan. Digitilization of xrays with computers in the OR is huge too. Now you don't have to go to hell and high water looking for a film on a patient and risk not finding it. The hiring of nurse practicioners in surgical teams to help with discharges/transfers etc helps free up the surgeon to do many other things.

Now Steve, I know you are a classic surgeon with the classic general surgeon menatality. You find it sad that things have changed, but are they all bad. Is is truly necessary to give your entire self to medicine and foresake your family/health etc? You actually may feel this is okay. I applaud your dedication, but is it necessary? You are right the medical student of the future is changing from what you are to a different animal completly. Why is this? Do these people really not care? I think it's a picture of society as a whole. There is no right or wrong answer.

I believe differently than you, but I am still dedicated to my patients. Does that make me or you wrong?

I don't know what I'm really writing here....

peace.

 

Oh, and good luck with residency!

 

Raj,
I think there are ways to better utilize our time BUT making it manditory was not the way to go. In your profession, you do have to work late and be there for emergencies, but its different on this side of the curtain. You see the patient for the procedure (and pre-op) but we also have to deal with post-op care/critical care. Now, what is REALLY important to instill in a young physician is dedication/ownership of the patient. You have to learn to get your a$$ out of bed and go see the person complaining of pain or chest pain or shortness of breath and not jsut write it off or sign it out. Why? b/c they trusted you to operate on them and that's not something to take lightly. Unfortunately, I see the youngins' want to operate, but when the clock strikes the golden hour, they are all too ready to sign out...regardless of how the patient is doing. IMO, that is pure BS!
Do I think I have to sacrafice everything....hopefully no. But, I do I have to put many things on hold for a period of 5yrs. Its a relatively short period of time to learn a lot of procedures as well as diagnoses and patient care.
With that said, there are ways to trim off our time in the hospital i.e. Home call, etc which we are working with.

 

You are right about ownership of the patient and I know from my surgical internship and ICU months how passing off patient's to a float system looses something in the change over no matter how good that change over is and how good the people involved are.

You are right the system needs be fixed. I guess I'm just really annoyed with how the ACGME does the things they do.

 

So am I. There are pleanty of ways we could save time i.e. PA's, or nurse practioners, but they cost money and where is that going to come from? I don't know about your medical school....but this one is running on a very tight budget.
I agree, the ACGME just said "Do it" and yet didn't give any time to adjust schedules, work on various systems, etc. They caved (like a bunch of candy-assed little girls) to political whims.

 

Dude why are you up so late?

I also have a big problem with the inhumanity showed toward residents. I think that's one thing that is causing some of these changes. It's not just work hours, it's the malignancy of things at times. God forbid that you get to spend time with your family at holidays and attend special family functions because of your duty. Just because you are a doctor does not make you inhuman. To me it seems that the medical community wants you to be inhuman. I think there is a change coming that will change the way training doctors are treated from punitive to supportive.

 

^ what a pantywaste! Awwww, I have a big group hug before rounds

 

That's why I love surgeons and why I'm glad I'm not one.

 

[QUOTE]^ what a pantywaste! Awwww, I have a big group hug before rounds