41–50 of 57 posts
Residents don't sleep much, so this doesn't surprise me at all. Related, the residency process needs to be massively reformed. The flimsy justification for making people responsible for human lives work 80 hours a week is usually that the long hours help them learn faster. But that's really BS. The brain has an incredibly hard time forming new memories when sleep deprived. I know a couple of nurses who often talk abo…
North American Neurosurgeon here. My opinions are based on my personal experience and my understanding of the literature. I am not an expert in residency well-being or work-hour restrictions. First: the literature is unequivocal about the effects of chronic sleep deprivation. This cellular aging article fits within what is known already. Sleep deprived humans are dumber, more stressed, and now age faster that non-sle…
Residents don't sleep much, so this doesn't surprise me at all. Related, the residency process needs to be massively reformed. The flimsy justification for making people responsible for human lives work 80 hours a week is usually that the long hours help them learn faster. But that's really BS. The brain has an incredibly hard time forming new memories when sleep deprived. I know a couple of nurses who often talk abo…
The pioneers of the modern residency system were fueled by copious amounts of cocaine & other stimulants. Perhaps we need to reevaluate the requirements & expectations we place on medical residents today. It's essentially a form of professional hazing, and I personally know many surgical residents that are literally operating on people today while absurdly sleep deprived (by no fault of their own, just the insane hou…
Earlier quoted context omitted.
The pioneers of the modern residency system were fueled by copious amounts of cocaine & other stimulants. Perhaps we need to reevaluate the requirements & expectations we place on medical residents today. It's essentially a form of professional hazing, and I personally know many surgical residents that are literally operating on people today while absurdly sleep deprived (by no fault of their own, just the insane hou…
One time I met with the head of an union and he told me many tough jobs (mining mainly) were perfomed while on drugs, which aren't available anymore causing all kinds of issues for the workers. I wonder if there was truth in that statement and maybe some formal research on this.
Getting prescribed "on/off" switches in pill form is a well-known thing in the military. You just can't do combat air patrol over remote areas of Asia without some uppers. This quickly went from the pilots (mid-grade officers) and other fight crew, to being adopted by folks who have to go halfway around the world routinely (flag officers).
It's an active topic of conversation, some do, some don't. As a military physician who was a line officer and has been through 5 years of graduate medical education (internship + residency), and now occasionally has to do those round-the-world trips, it's not clear to me that there's an obvious right answer in policy or per-person. We (leaders and followers alike) expect leaders to function at the outer limits of human capacity, and have for a long time. I can tell you this: it doesn't get easier with age: a fairly common definition of success as a leader is proving your ability to take on more responsibility, so the more you do, the harder it gets. So avoid starting early.
North American Neurosurgeon here. My opinions are based on my personal experience and my understanding of the literature. I am not an expert in residency well-being or work-hour restrictions. First: the literature is unequivocal about the effects of chronic sleep deprivation. This cellular aging article fits within what is known already. Sleep deprived humans are dumber, more stressed, and now age faster that non-sle…
Do you think hyper-specializing might be a solution? Right now I see many physicians end up only working within a narrow sub field of the field they trained in. For example, a neurologist goes through 4 years of general neurology training and then ends up only working in an epilepsy clinic and after a few years probably forgot how to manage myasthenia gravis. Or a neurosurgeon that ends up only doing spine cases. Wou…
Sub-specialists are needed and are important for a variety of reasons, including realistic demands on training time. If my loved one had a single medical issue, I would certainly wanted them operated on by the person who does nothing but that operation.
Woe is the person with two complex medical issues in a hyper-specialized hospital institution. Consider the situation where someone has two medical problems in direct conflict with each other. For instance: some people can develop chronic subdural hematomas (translated: blood clots on the surface of the brain) which causes neurologic dysfunction. The general advice here is to stop any blot-clotting medication someone is on, to prevent further bleeding or expansion of the cSDH. However, what if that person has an artificial heart valve and needs to be on blood thinners to prevent strokes?
How do we proceed? Ask the neurosurgeon, and the answer is "stop." Ask the cardiologist, and the answer is "don't stop."
Sub-specialization is happening, and it's important. But it turns physicians into finer-grained hammers: so every problem they can hit becomes a nail.
In my opinion, one will always need generalists to make the tough calls and to identify which specialist is required. The only way to train generalists is to know what the outcomes are for both stopping and continuing the blot clotting medication.
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It sounds like the strategy is put in a lot of hours doing routine cases (where little learning happens) in order to experience the rare cases. This seems inefficient? Couldn't residents be called in to look at the rare cases? I guess they would need to be close by when it happens, but that doesn't seem to justify sleep deprivation? Or maybe there are other ways to increase the odds of seeing a rare case?
This is the difference between coding the solution to a tough technical problem yourself versus watching someone else code it. There can only be so many assistants.
The five years of training are needed to understand why you're doing it, and to see enough disasters to know how to get yourself out of the disaster situations.
While I don't fly planes, I would imagine flying a plane would be similar.
I also drive a car. While I was technically proficient while I got my license, it took years to get to the point of predicting the behavior of other drivers on the road, and to not panic when unexpected events happened (hydroplaning, odd pedestrian behavior, etc.).
North American Neurosurgeon here. My opinions are based on my personal experience and my understanding of the literature. I am not an expert in residency well-being or work-hour restrictions. First: the literature is unequivocal about the effects of chronic sleep deprivation. This cellular aging article fits within what is known already. Sleep deprived humans are dumber, more stressed, and now age faster that non-sle…
First of all thanks for this comment. That's a lot of interesting input. To be honest I don't really see any reason to treat doctors differently than other professionals. There are plenty of difficult jobs that people's lives depend upon but I've yet to see a career path forcing trainees or juniors to go through such hard conditions for several years for pennies. > Further work hour restrictions could turn the 15-yea…
https://medschool.ucsd.edu/som/medicine/education/residency/...
https://med.nyu.edu/medicine/education/residency-compensatio...
http://www.myparo.ca/starting-residency/#salary-and-benefits
While these salaries may be dramatically different than what the doctors make when they finish residency, you'll see they're decent.
That being said: as a first year resident I once did the math and found that based on the number of hours I was working per month, I was making less than minimum wage.
Could we pay residents better? Absolutely. But, my suspicion is that people would still want to be doctors even if you paid residents half of what they currently made. I don't think medical school admissions would sky-rocket if you paid residents twice as much as they were making right now.
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>this seems insane A little bit. Big part of the issue was that the professional exam results were published by originating university. So there was this really perverse incentive for universities to send only the most battle hardened candidates into the process to kept the very public stats on the uni's performance on these independent professional exams high. And if you think that's wild - it gets better. This bein…
> Alas in my particular world (Accounting/auditing) it is. 3 months of soul crushing stress and rest of year is more relaxed. Rinse & repeat. Cripes. And I bet that the soul-crushing stress even after you've gotten the license is probably because you don't have enough people licensed to do the work, which in turn is because the universities try to keep their stats high which artificially restricts the supply. And the…
>it really sounds to me like the supply of that capability is dangerously restricted
In some countries yes quite restricted, don't think dangerously so. Way more scared of them rubberstamping poor candidates. Plus auditing isn't particularly difficult to be honest.
>one of those things that's certainly necessary for the smooth functioning of civilization
Maybe. I'm not 100% convinced. I'll definitely take the job security though.
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What are some good reasons that things are organized this way? I’ve heard that long shifts help with continuity as fewer doctors need to pass information about the same patient thus reducing communications overhead a bit. Anything else? If only that, it seems the drawbacks in terms of risks to care quality as well as to the resident’s learning & long-term health may be greater than the benefits.
I think 'needlesurgeon's answer otherplace in this thread answers this well. Especially in adressing the point that it is in a way essentially a numbers game; It takes a certain patient population size to provide sufficient volume and diversity of cases per year to educate a certain number of surgeons over a certain span of years. You could make on-call easier by thinning this out over more surgeons-in-training, but…
Earlier quoted context omitted.
Do you think hyper-specializing might be a solution? Right now I see many physicians end up only working within a narrow sub field of the field they trained in. For example, a neurologist goes through 4 years of general neurology training and then ends up only working in an epilepsy clinic and after a few years probably forgot how to manage myasthenia gravis. Or a neurosurgeon that ends up only doing spine cases. Wou…
Hyper-specialization has been an approach taken by the medical establishment. For instance, within the last decade, the "vascular surgery" specialty opened up as a specialty straight out of medical school. Vascular surgery procedures used to be a subset of procedures largely (but not exclusively) performed by general surgeons (neurosurgeons still routinely do carotid endarterectomy procedures, for example). There are…
(resident neurologist here) :)