pertinent jbjs article

Pretty much states the obvious. Now the real question, will this change anything?

What do you want them to change? They are talking about cutting hours again and lengthening residency. who would want to be a resident longer? Especially with mid levels working to get more autonomy and abilities. Soon being a physician will take much longer with less upside. People will just become mid levels. I hear more people say they are going to be NP or CRNAs than going to medical school.

Hiring more midlevels and secretaries to take care of non-medical work would certainly help reduce hours required of a resident.

Its a cross sectional study so there is only so much we can glean from it. I did find it pretty interesting though how the satisfacton of the attendings dropped after teh ACGME work hour restrictions and how the residents at the smaller programs appeared to be less stressed, more satisfied, and cope better than those at the larger academic programs. I wonder what their cutoff for large and small programs is.

Never said I wanted them to change anything, was just wondering if such a study that states the blantant obvious has any real impact.

It may seem blatantly obvious but still needs to be supported by a study. People thought it was blatantly obvious that beta blockers were bad in patients with chronic heart failure until studies showed they actually saved lives.

I believe the goal of the study was to actually show there may be a problem with actual data versus just saying there is a problem.

But yes, whether or not anything should be done about it is quite the dilemma.

Do we really need a study to prove working 80+ hour weeks makes people tired and causes them to burn out?

That's like having a study that proves shoving a hot poker up your butt hurts.

Plus, this is nothing new, they've known this for decades in aviation (pilot and air traffic controller fatigue).

So unless the study proposes an actual solution, it was a waste of money, in my opinion of course.

We read this article for my program's journal club, and this was my article to summarize. The biggest concerning point for me was the question about how many current orthopedic residents would choose a field, other than medicine, if given the choice again. 23% responded "yes." Almost 1/4 orthopedic residents who answered the survey wouldn't do it all over again, if given the chance. That is an astounding number, and doesn't speak well for the future of medicine.

There was a very low response rate to this 119-question survey, so that must be taken into account as well. The authors stated they couldn't figure out if happier or more disgruntled residents were more likely to fill it out, however, so it's tough to tell which cross-section of residents this comes from.

Was the data broken down by training year? I'd be interested to see if that 23% was mostly PGY-2s, arguable the toughest year at most programs.

As the saying goes:
Lies, damn lies, and statistics...

*sigh* this whole burnout thing 80 hour work week debate makes me sad.

First. the argument about beta blockers and doing a study and finding out the contrary... is a very different concept. The effects of fatigue are well known and already shown as has been previously stated. It's behavioral in nature as well. A mouse is willing to ding a buzzer 10 times to get a food pellet, but doing it a 100 times makes it less likely...

It's obvious that everyone wants to learn the most they can in residency with putting the least amount of work in, or more appropriately, not being exhausted all of the time..

The argument that patient care is compromised by doing residency work hours.. is totally bogus. That's a problem with the medical system and signouts.. not the residents.

And don't get me started about the cost of healthcare by increasing the number or residents, extenders. that argument is also rediculous. Although it's true, if you have fewer people doing the work that requires many more people.. yes, it's cheaper.. duh. But is that really fair to have residents pick up the slack?

I'm surprised JBJS published this article.. I feel like they have a huge bias on this issue. IE check an article in jbjs a couple of months ago that compared morbidity rates before/after the acgme changed over by using a nationally based database. Their goal was to show that there was increased morbidity in "teaching" institutions.. which there was....but for some odd reason that year, it increased in community hospitals too.. just not as much.. so what's that about? The article raised more questions than answered (see commentary).

Let's face it.. most of the time in residency, medical school is spent.. waiting aroud. You're not working 100% of the time, and you're not learning 100% of the time either.. so inherently, there's waste. OR's are delayed, cases take longer.. etc. etc. So we pick up the slack with more time.. who cares. The 80 hour work week is just there to protect the residents from being abused, not so that resident can say "peace out.. I gotta go golf" or something.

The idea of getting up to be in the hospital on a normal day to round at 3:30 or 4:30 am.. just boggles my mind. As a patient, I would *NEVER* want to be bothered that early.. even 6am is pushing it. People need their rest.. there's psychology involved in that as well.

But in the end.. we all want to be orthopaedists.. so we're willing to go through with whatever we have to and do it with a smile.. I know I am..

Residency work restrictions, etc. is an evolving concept.. and the medical systems need to change to reflect this.. This will take time.

In the mean time, the real question is if our (*cough* hopefully our, in my case.. soon *crosses fingers*) field is suffering because people don't want to do it.. which I think this article tries to raise that point.

It's clear that many medical students are afraid of pursueing a surgical field because of this issue. So the question is, are we effectively weeding in those who really want to do it... or are we cutting our nose to spite our face, and losing the best candidates?