So… apparently the the work hour gremlin thing is coming around the corner again… or I got used to its smell.
While it may be a good thing for many, it seems like it may ultimately be more detrimental to Neurosurgery (in my opinion).
Feel free to enlighten if you think this is a wrong assement.

“At the end of April, the Accreditation Council for Graduate Medical Education , which determines work rules for residents, will unveil a proposal that could further shorten workweeks. If approved, the new rules would take effect in July 2011. “
- http://www.washingtonpost.com/wp-dyn/content/article/2010/03/17/AR2010031704006_2.html?sid=ST2010031804586

I know neurosurgery made an argument regarding the negative impact of this on training..(...extended residency…
Dr. Batjer et all made a good presentation which is at

http://www.iom.edu/~/media/Files/Activity%20Files/Workforce/ResidentDutyHours/LessonsfromSurgeryTheFatigueProfessionalismBalanceBatjer.ashx

but I haven’t heard what else neurosurgery could do to its defense. Do we all need to be more vocal, proactive in some way?
Sure, more scut could be cut out, and more resources could be put into optimizing resident teaching/operating time/rest...but I don’t see who would want to pay for that.

Just trying to see what others thoughts/ideas/understanding/suggestions may be. If its going to happen perhaps some discussion, or preemptive action could be taken.....

I don’t think there should be duty hour limits, per se. Instead, residents should be paid overtime above 60 hours a week or so. It would be cheaper than hiring midlevels.

just an update of things to come in case anyone was curious.....

http://www.acgme.org/acWebsite/home/NascaLetterCommunity5_4_10.pdf

I’ll post the first paragraph, you can use the link above for the rest......

“May 4, 2010

Dear Program Directors, Members of the Faculty, Designated Institutional Officials,
Residents and Fellows of the United States,
It has been about five months since I last shared an update on the progress of the task
force charged with drafting standards relating to professional responsibility, transitions
in care, supervision and resident duty hours for the profession.  I am pleased to relate
that the work of the group is nearly complete, and that their recommendations will
soon begin to traverse the path that all program requirement revisions must follow on
their way to approval by the ACGME Board of Directors .
“

New Standards are posted for review:

http://acgme-2010standards.org/pdf/Proposed_Standards.pdf

comments?

I don’t think that one is going to fly since it practically eliminates O/N call for PGY1’s.  Many PD’s and chairmen already feel as though residents aren’t receiving adequate time for training, and I am sure they will believe this will cripple the foundation of intern year.  Plus after taking call as a med student I would feel as though I am regressing.

http://www.earthtimes.org/articles/press/resident-work-hour-rules,1359909.html

The SNS, AANS an CNS both support the new guidelines. Its going to happen folks.

I don’t see a change.  The article says that it is going to stay the same (80 hrs / week averaged over 4 weeks), which explains why it is supported by all the societies.  I think this is a good thing—any more restrictions will make the residency 10 years long.

If you read the guidelines it does essentially remove o/n call for pgy1s as they have to have an attending in house at all times when they are working. Additionally they can work a max 16 hour shift. Other years can work a max 24 hour shift...going to be interesting

Again, this is a proposal.  I am thinking it might go for a test run, but is not necessarily mandatory across the board as of yet.  If you look at website there is also a timeline for further revision before the beginning of fall.

sorry one quick question from a first year med student....what is the current resident work week capped at in terms of hours per week? I know someone mentioned 80 hours a week averaged over 4 weeks, what exactly does that mean?

does this mean no call? All I know is on my gen surg inpatient rotation I was on q2-q3 for a month (with basically no pre or post call meaning leaving at 1pm the next day) that easily was over 100 hours every week. It seems like it would be an entirely different experience without any call.

hgbrain - 25 June 2010 06:28 AM

sorry one quick question from a first year med student....what is the current resident work week capped at in terms of hours per week? I know someone mentioned 80 hours a week averaged over 4 weeks, what exactly does that mean?

The current cap is 80 hours or 88 hours/week averaged over a 4 week interval.  The 88 hour week is an exception in order to provide continuity of care and didactic training as felt fit by the program if reasonable explanation can be provided.  This ultimately means that your hours for a month should average out to at least this weekly “work rate” as long as other guidelines set by ACGME are met for each work day ie...24-30 hour work day caps with the appropriate time b/w shifts.

Not only does this shut out any possibility of PGY1 o/n call (16h shifts?!) but it requires in house seniors and prob a night float system. I know some programs keep seniors in house but how are 1 and 2 resident/yr programs going to handle this? I don’t want to be a q2-4 senior resident or move towards 10y programs. I don’t see this working for nsgy.

http://www.medpagetoday.com/PracticeManagement/StaffingScheduling/22048

It looks like the govt (OSHA) may impose even further restrictions on work hours. Unfortunately for the new residents coming up this will probably mean less experience or a longer residency.

ahh i hope that its not a longer residency.. i should be starting a residency in like 2 years.... thats going to suck if that happenes…