surgical specialties competetiveness and an 80 hr week

[ckent]

Will all surgical residencies become more competetive with an 80 hr rule being enforced? I think that it will. I think that there are a lot of people that choose fields other then surgery simply because they are unable to tolerate a 100-120 hr week in the OR. With 80 hrs, your surgical residents will be working as many hours as your internal medicine residents and your psych residents, and etc. Most surgeons make more then the average non-surgical physician, and we all know that med students, on a whole, follow the money. By taking the time factor out of the equation, I think that there will be a lot more people looking at surgical careers. And since there will be more people looking at surgical specialties as a career, it will become more competitive. Thoughts?

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[jt999]

When was the last time you saw an IM or psych resident work 80hours/week?

I'm not sure how the new laws will affect working hours. In NY, we already have those laws and all it means is that the residents write they work 80 hours/week when they work 100-120.

 

[womansurg]

I guess my own inclination was to think along those same lines, ckent. After all, surgery is amazingly interesting, fun, fulfilling... Practically the only drawbacks have been the lifestyle and the abusive training. With those being moderated, I would think that a lot of folks who were siphoned off by 'gentler' surgical subspecialties would now be inclined to stick with gen surg.

For instance, one of our interns left to go to ENT, and sheepishly admitted that he thought the practice would be not nearly as interesting ('sucking snot' he called it...), but this way he could still do surgery while having time to see his newborn grow up during his training.

 

[tripod]

whoah that's amazing
there was actually an opening for an ENT spot available?

 

[womansurg]

Yeah, this guy was a real sharp competitor - stellar numbers, great recs, etc. Apparently he had looked into ENT before deciding on gen surg, and was already somewhat known in that community. I'm not sure if they had an opening or just made a position for him or what, to be honest.

 

[ortho2003]

I think the same people that don't want to work the crazy hours of a surgical subspecialty during residency will not want to work the 60-70 hours they work when in practice. I doubt you will see many more apps.

 

[samsonlee]

working 80 hours a week seems good, but all it does is make you less of a surgeon, your case load goes down by 1/3, thus the inevitable result is they are going to make residency longer, I'd rather suck it up; if you don't want to work, you shouldn't become a surgeon

 

[Winged Scapula]

samsonlee -

Just wonderin' where you're getting the data that your case load "will go down by 1/3" with the reduction in work hours?

I don't know where you are in your training, but as its been noted here time and time again, a large proportion of the 80+++ work hour weeks are NOT spent operating (even for the Chiefs) but rather often doing things with little educational value (especially for the junior house officers) - things like WAITING for the OR to start, WAITING for patients in clinic, WAITING for the Chief to get out of the OR (on a case which you couldn't scrub because there were already too many people in there) so you can round, WAITING for labs to be drawn, sent, analyzed, removing rectal tubes, chest tubes, etc. (which are of little value after the nth one done), etc.

We are doing much less call now (average of q5 on most rotations) in an effort to reduce the hours (its still more than 80 on most rotations) so in effect, even though we're going home post-call at noon, we're only missing 1/2 day a week of potential OR time - hardly 1/3 of the training.

 

[Skylizard]

How do you figure case load drops by 1/3? That sounds like an old school surgery attending statement as to why everyone should live at the hospital. Just to echo the sentiment with a quote:

Originally posted by SomeOne
...I can tell you from first hand experience that a great deal of the 110-120 hours per week are not true learning experiences?On those long 115 hour weeks, I found myself missing ALL the basic science lectures, all the M&M conferences, and all the lectures in general. Was it because I was in the OR? Hell no, it was because I was a resident doing the tasks left behind due to insufficient nursing staff or some other menial task...the kind of thing that got Yale in trouble. Residents doing non-academic menial tasks...

As for competitiveness:

Originally posted by SomeOne
...I think individuals who thought they would not be competitive in surgery due to any number of reasons (usmle, grades, or lack of research experience) are now hoping surgery programs are hard up and will now take a second look at them. Thus, the "B-team" of applicants is now growing. Some individuals that did not think they had a chance in hell have seen the "big university" names that did not match over the past several years. This has probably given a false sense of hope to some...

While the number of applicants may be on the rise, I suspect the number of ?traditionally? competitive applicants is about the same. I may be wrong, but, the number increase is probably secondary to an increase in the foreign grads and the bottom pool of US grads. If you would have been competitive last year or the year before, you are likely to be just as competitive if not more now. The increasing applicant pool will be filling out the community programs and on occasion the unmatched university spot.

 

[womansurg]

Originally posted by Skylizard
If you would have been competitive last year or the year before, you are likely to be just as competitive if not more now. The increasing applicant pool will be filling out the community programs and on occasion the unmatched university spot.

I've beat this drum before...

It is FAR more often the university programs rather than the community programs which
1. fail to fill
2. have to scramble
3. fill spots with FMGs
4. have residents score poorly on the ABSITE

I'm from Iowa Methodist Medical Center. We take 3 categoricals per year. The average board scores of our accepted interns is 240. This year we have three applicants with scores in the 250 to 260 range. AOA is typical. We get the top people from the regional medical schools, while the U programs sometimes go unfilled. It was the same way when I was a student at Ohio State.

We don't have to look beyond the top 5 of our rank list to fill and we've never taken a FMG or a DO (sorry - I don't personally agree with this policy). About half of our residents score above 90th percentile on absites. We graduate with >1200 cases and folks wanting fellowships have been very competitive (my classmate matched into plastics this year and had his pick of programs).

The people we take could easily match at Mayo or U of wherever if they so desired; they choose our program for the many benefits and relatively fewer detractors that it offers. Don't buy the propagana that your university biased surgery departments feed you - look into the facts for yourself.

regards

 

[droliver]

Originally posted by womansurg
I've beat this drum before...
It is FAR more often the university programs rather than the community programs which
1. fail to fill
2. have to scramble
3. fill spots with FMGs
4. have residents score poorly on the ABSITE

In fairness, I don't know that's the case across the vast majority of community programs across the county. Your program in Iowa tends to pull a self-selecting & non-representative pool of applicants because it is a very good (one of the best I'd submit) community programs. It's also a little hard to compare the match rate and how far your rank list goes b/w programs as you're talking about ones that range b/w one resident & sometime 10 or more a year (ours is 8 & applying for 9). The majority of categorical spots unfilled last year also continue to be from private programs.

 

[southerndoc]

The 80-hour workweek should raise the numbers for USMLE, grades, etc. if it causes more applicants.

If one examines those programs that have less rigorous call schedules, less weekly time demands, etc., then you would notice that they are the most competitive. I'm speaking of dermatology, radiology, emergency medicine, etc.

An influx of these applicants into the general surgery pool should cause the mean USMLE scores, grades, etc. to increase.

 

[droliver]

Actually, a larger sample size (in this case applicants) usually tends to bring the average of whatever you look at down. Also there is a tendency for many people going into surgery to look @ the quality of the training or prestige of a program over "lifestyle" issues. For an oppurtunity to train @ the best programs, many would accept the trade offs that go with that. As you get away from those top programs and the presumed benefits they'd have on your career, I think the other factors come more into play. With the contracted applicant pool, those programs have to sell themselves more & make some of these concessions more than ever in order to attract people to come

 

[Skylizard]

Originally posted by pba
There are a few community programs that are real gems...william beaumont, henry ford...

I can not speak to many community programs, but I know enough about Henry Ford & William Beaumont to agree with you.

Originally posted by pba
...i hear community surgery people say they can operate better than university guys......

I have seen lousy surgeons and spectacular surgeons at both university and community. When I was doing internship at a university program, nurses routinely said they would only go to the community hospital down the street for surgical care!!! It just depends on the program and what it looks for in its staff.

Originally posted by pba
...that community places have AWESOME O.R. TURNOVER TIMES. boom boom boom, like clockwork...-pba...

Turnover is often a matter of financing, ancillary care, and politics, etc... Does your hospital have a union for nurses? Unions can sometimes slow down your OR. Does your hospital have enough nursing/OR staff? I do not think I would say turnover is strictly split U verse community.

I think traditionally you get earlier and more OR time in community programs verse university programs but I can't say I have any studies to back this statement.

just my opinions and experience.

 

[droliver]

Operating room turnover time @ University hospitals has been frequently identified as a large potential problem facing surgery with the new work hour regulations. The problem as I see it is a lack of financial incentive and the fixed shift schedules for the various people involved.... the nurses,scrub techs, anesthesiologists & crna's , housekeeping etc.... None of them have the same agenda as I have- that being starting cases on time & minimizing turnover time in order to get more work done. The more efficient things are, the more work there is for them is the way they seem to feel about it. In addition, as things drag on they frequently get paid overtime if they stay beyond their normal shift hours. This tends to be less of an issue @ private hospitals as there are stong financial incentives of the hospitals and anesthesia groups to be cost-effective, in addition to the fact that they get to go home when things are thru.

 

[Skylizard]

Originally posted by pba
...i didnt want a smiley face d@#nit
-pba

Hey, pba: You can always edit your reply once posted if you want to...just use the edit button underneath it.

 

[Skylizard]

Originally posted by pba
...the more you operate, the better you get. i wonder why the ACGME wants only 500-1500 cases for surg programs...i am presently under the impression that quantity (with associated caseload diversity) is the same thing as quality...-pba

In general, I would agree with the statement "the more you operate, the better you get". However, the rules are a little more complex then just numbers. There are a certain number/percentage of your cases that must be of certain types and you must be a "senior" surgeon for a certain number/percentage. That is why in many programs you spend up to 12 months on a general surgery service during your PGY5/chief year.

Just a thought for you, placing a 3 lumen central line is a procedure, placing a broviac in the OR is a "case". So, numbers without description do not give the full picture. The question is how much of that 1500 cases would be described as "major"? Nobody finishes with 1800 major cases as a "senior surgeon".

I suspect any attempt to limit the total number of cases you finish with is an effort to streamline and ensure you:

1. get the specific number of complex cases you require and to keep you in the big cases and not sent as a chief to do a lipoma resection
&
2. by streamlining and ensuring your training is based on a thought out plan (as opposed to luck of the draw), you can also prevent overworking residents and enhance training....in theory.


later