Guest - 26 July 2007 05:39 AM

says the guy who doesn’t have a 250?

come on people. everyone is smart enough to know numbers alone doesn’t mean everything. But it is an indicator of how hard a student has worked.

Try again, I beat it by 2.  I personally think it’s an indicator of how well you took the test on the days that you took it.  If we’re all smart enough to know it doesn’t mean everything, then why does it keep coming up?  I’m just sick of these megalomaniacal nobodies pumping themselves up as if they were somehow more than ordinary neurosurgeons.

I realize that this thread is rapidly becoming more pointless with each passing moment, but I wanted to chime in and play captain obvious for a minute:

1.  The “old boys’, be it a year ahead of you or 25 years ahead of you will ALWAYS complain about how much harder they had it and how much the new generation sucks and doesn’t work hard enough.  As many of you know, this is not just in neurosurgery but in EVERY FIELD OF MEDICINE.  Call it a rite of passage…..or whatever.  We all do it in one way or another and we will continue to do so as long as we live.  As one reaches the emeritus status the burden of telling everyone else how hard it was for you increases 10 fold, so you’d better be ready with lots of embellished stories and crazy anecdotes to keep people trying to stay away from you at parties/meetings indefinitely.  The point here is that its always harder for those above you and your training is always inferior to those above you.  Just do us all a favor and get used to it.  Uphill both directions, snow, barefoot, the whole 9.  Just smile and nod and pretend to be in awe. 
2.  In all seriousness, neurosurgery (and general surgery and every other heavily loaded specialty) will be just fine in the age of “88 hour weeks”.  Now, most of us know that 80 or 88 hours is still just an approximation……at my institution there is much more work to be done than is possible in 88 hours.  We just do what we have to.  Things are getting better and that’s good.  These sort of things always seem to work themselves out.  If a surgeon isn’t “good enough” his outcomes will dictate his future…….survival of the fittest.  This applies to many areas of life.  Your training is only as good as you make it.  The tools don’t make the carpenter….etc.  In 15 years everyone who is training now will be telling those little bastards of the 70 hour weeks how hard they had it.

CHICAGO Internalmedicine faculty heavily involved in residency programs believe that residentduty-hour limitations negatively affect aspects of residents patient care,education and professionalism, but improve residents well-being, according to areport in the July 23 issue of Archives of Internal Medicine, one of the JAMA/Archivesjournals.

Guest - 25 July 2007 03:58 PM

...And I’m smart enough to know practice makes perfect, and 130 hours of practice vs. 80 hrs of practice is much better…

Not quite...as Vince Lombardi reminded us all...practice doesn’t make perfect; perfect practice makes perfect.  Come-on...it’s about quality, not quantity.  The quality of your work and training as a resident is what will help make you a great surgeon.  You can have high quality and either low or high quantity and still achieve greatness, but without the quality, no matter how many or how few hours you work (140 hours of work per week, not including travel time to and from work, leaves exactly 4 hours per 24 hour period, 7 days a week, for 6 to 7 years, to shower, shit, shave, sleep and have sex), you and your patients will have little chance.

So, please stop making this all about the hours...they are all meaningless UNLESS they are backed up with quality.

To put it another way...to all of you great neurosurgeons (residents and attendings alike) out there...stop selling yourself and this calling short by implying that you owe your greatness simply to the number of hours you work(ed) during residency.  You are great because of the quality you put into it, and would have been just as great if not more - with the same level of quality - had you worked fewer hours.

sex? nobody in this thread has ever had sex

Guest - 25 July 2007 03:58 PM

Guest - 25 July 2007 03:07 PM

You old guys are stupid and I will never understand how you function. I will admit it. If it were not for the 80 hour work week, I would not have even considered neurosurgery. I believe in working to live, not living to work. I do not love neurosurgery or anything else so much that I am willing to sacrafice everything else in my life for it. I was a >250 on step 1, AOA at a top 10 school smart applicant and I’m smart enough to know that working too much is just plain dumb. There is a law of diminishing returns when it comes to overnight work and scut. Neurosurgery is a fantastic field and I am grateful that I will be able to get the same training you old guys did, only in a more efficient way, while having time to eat, sleep, work out, and take care of myself. A neurosurgery resident at my medical school once told me that if you can’t learn your medical speciality in 80 hours/week, you probably shouldn’t be in it anyway. I am confindent that I will work hard and learn neurosurgery as best as possible in 80 hours or less and if you old guys don’t believe me, the advances to the field that my peers and I will make will speak for themselves. We will probably also be better leaders because we’re not dumb enough to think that working more equals better training, patient safety or toughness. It just equals stupidity and following, not leading. Just my 2 cents.

Badass PGY 2 sigining out, post call and got home around 1:30 this afternoon.

I too am >250 AOA Top 10 (probably 5) PGY 3.  I’m therefore also a pretty smart guy because we have very similar stats, according to your logic.  And I’m smart enough to know practice makes perfect, and 130 hours of practice vs. 80 hrs of practice is much better.  It’s why the seasoned elites have lower mortalities than fresh newbie PGY-2’s.  If you’re doing 130 hrs of scut, I agree.  You’re just a glorified nurse, without the free bj’s.

But the best leaders do work only 32 hours a week.  They operate, research, teach conferences, and train new residents.  They sleep a full 8 hours a day.  Spetzler, Carson, Grady all sleep 9 and a half.

Pure fucking brilliance.  You will never be a leader with that attitude.  100 bucks says youre going to be a private practice sellout doing fusions, converting your hundred dollar bills to dollar coins so you can sit on it and think you’re the smart one.  Maybe you are, but you are in no way a leader, don’t kid yourself.

Badass PGY3 post call hour 38 not signing out until my paper is submitted (t minus 30 minutes).

I do not know about Dr. Carson and Dr. Spetzler, but I know for a fact Sean Grady does not sleep that much. I cannot think of any neurosurgeons who get more than 6 hours of sleep on a consistent basis, even when on vacation.

As far as leading and learning goes, I try to specialize in efficiency. I am early in my training, but already have a respectable research profile. I have learned to bust my ass during my designated work times, and to rest or play when it’s time for that. I do not beleive in all work no play, or working hard just to work hard. I believe in working smart. I do not cut corners, I do not repeat tasks, I am a thoughtful physician who tries to be as efficient as possible. Whether I like it or not, I only have 80 hours per week to learn this specialty. I plan on reading my ass off during my research years. I approach each operation with the upmost seriousness and I have learned tremendously. I do not understand the mentality of those who are willing to sacrafice their entires lives just for neurosurgery, but are unwilling to instead find ways to become more efficient. Besides, most of the hours beyond 80 are at night doing scut and not in the OR. I apologize if I pissed some of you off, but if you think that working 130 hours per week equals better training, you are following the lead of idiot Harvey Cushing descedants. There is a new wind a blowing!

Badass, now humbled PGY2.

Guest - 26 July 2007 12:38 PM

sex? nobody in this thread has ever had sex

now now… one should only speak for oneself on this matter. clearly you spoke for yourself.

Guest - 26 July 2007 12:23 PM

Guest - 25 July 2007 03:58 PM

...And I’m smart enough to know practice makes perfect, and 130 hours of practice vs. 80 hrs of practice is much better…

Not quite...as Vince Lombardi reminded us all...practice doesn’t make perfect; perfect practice makes perfect.  Come-on...it’s about quality, not quantity.  The quality of your work and training as a resident is what will help make you a great surgeon.  You can have high quality and either low or high quantity and still achieve greatness, but without the quality, no matter how many or how few hours you work (140 hours of work per week, not including travel time to and from work, leaves exactly 4 hours per 24 hour period, 7 days a week, for 6 to 7 years, to shower, shit, shave, sleep and have sex), you and your patients will have little chance.

So, please stop making this all about the hours...they are all meaningless UNLESS they are backed up with quality.

To put it another way...to all of you great neurosurgeons (residents and attendings alike) out there...stop selling yourself and this calling short by implying that you owe your greatness simply to the number of hours you work(ed) during residency.  You are great because of the quality you put into it, and would have been just as great if not more - with the same level of quality - had you worked fewer hours.

I went to Lombardi Middle School and my basketball coach reminded us of that quote EVERY day!  I thought I had escaped him . . .

i assumed it was a fair assumption that by this point in our training if you were shitting away your hours on the floor, you were accepted to your residency by praying to Thor while sleeping with the residents and attendings.

>80hrs of non-scut work per week is very doable; its unthinkable that programs actually function without good PA’s to take care of this.  2 fusions and a crani a day puts you at 12 easy, and if you get dicked on call, that’s 84hrs right there, without followup and all those other things that just need to be done.  if you think 80 is enough, your program isn’t busy enough, or youre not getting enough cases.

120 can be ridiculous, but if you think 80 is enough, that’s worth as much as what i’m putting in the toilet right now.  you take away the BS those 130hr cushing-contemporaries trained you should end up with a solid 100 hrs of good time in the hospital.  Hell, as a third year I put in 90hrs a week on internal medicine and used every second, except meals, for patient care or reading.  If a med student can do it on an internal rotation, a neurosurgeon can certainly put that same time to equally good use.