It's been 16 days since John had a day off, and his last day off capped a 13 day streak. This time last year, when the new ACGME regulations kicked in, wasn't nearly as crazy. Go figure. Anyway, I'm going to try posting about residency without being derailed by sarcasm or invective. (Must...not...drop...F-Bomb....)
Doc Russia commented below about how hospitals benefit from squeezing residents for all they're worth, rather than hiring physician's assistants. (I've posted about this myself, with facts and figures here). I was wondering if, as a medical student, he has been exploited more since the regulations limiting residents' hours have gone into effect. This reminded me of something awful that happened about 5 years ago, and how it took a potential fatality to stop egregious exploitation of medical students.
My husband went to medical school in New York, where the Bell Commission laws have limited residents to 80 hours per week since 1989. Enforcement was spotty statewide until about 1998, but was generally good at that hospital. Unfortunately, some departments (especially OB and Vascular Surgery), deprived of cheap resident labor, started exploiting medical students instead hiring PAs or nurse practitioners.
An exhausted medical student removed sutures from a patient much too early, causing a massive bleed. Fortunately, the patient recovered. But the rumors started flying: the medical student in question was at the top of the class, should have known better, and therefore must have done it deliberately to draw attention to the abuse perpetrated by the vascular surgeons. I refuse to believe this; it's almost too horrifying to contemplate. But an environment so toxic that such rumors can flourish is almost as disturbing as the incident itself.
In the aftermath, the Vascular Surgery Department hired 3 PAs to do their scutwork. My guess is that their combined salaries totalled about $200,000 per year. To belabor my point, residents (and medical students) are cheap labor for hospitals. I would be less angry about the whole situation if the Powers That Be would just admit it. It's hard to buy the argument that "it's about training" when inadequately supervised residents or students (cheap and free labor, respectively) are endangering vulnerable patients. How very convenient that this training regimen is good for the hospital's bottom line.
Not just free labor, we're PAYING to be there! Sometimes on rounds I think to myself, "I don't know how these patients survive being taken care of 99% of the time by people who haven't finished their medical educations yet!" That goes for residents and students.
Posted by: Todd | August 03, 2004 at 08:17 PM
On balance, I spent all of my residency well supervised and felt very supported. I think there is plenty wrong with the world of residencies but there is plenty right. The goal of patient care was always quality above quantity since that is what being a doctor is all about. The opinons and perspectives expressed on this site reflect mostly the conventionanl wisdom found mostly in the surgical residencies. For those that think the 80 hour work week is not going to be the answer, I think they are naive. Until there is a change in the conventional wisdom that forms the basis of surgical training in this country (and some other disciplines), not much is going to change with the treatment of surgical residents. When choosing a residency one must decide if they can live with the current training provided by a residency. I had a great residency in Pediatrics and now a great fellowship in Neonatology. I decided long ago that I could not be happy as a surgeon.....god bless those that make that decision since we need great surgeons....we just don't need ones that perpetuate the current system.
On the side....I can't say I agree with your politics and these days am struggling to even appreciate it however, thanks for the perspectives on residencies in this blog...not many outside of medicine know anything about what really happens in teaching hospitals at times. Maybe someone will stumble on this blog like I did.
Posted by: Ashley Ross | September 20, 2004 at 01:23 AM