And even if you discount this factor, I have doubts that the European hours adjustment would necessarily do that much to extend the residency. Think about it, in these crazy 80-hour (or more like 90 hour, in reality) work weeks we have in the USA, how much of that is actual training? And how much is utterly useless scut (though not all scut is bad)?

I’d say that maybe 20-25% of residency in the USA is actual training, the rest is gopher-work for the hospital for low pay that contributes little to training. That is– the European training-to-scut ratio is much better than in the USA.

So somebody training in, say, Milan or Barcelona or Berlin can have their cake and eat it too– more of an actual life while in residency, and still finish in a decent number of years since they’re not being scutted out, but actually training.

This has been basically borne out from what I’ve seen– I’ve met a good number of Europeans who’ve finished their fellowships, boarded in IM specialties like GI and Cardio, and they’re almost always younger, often a good deal, than the same people finishing fellowships in the USA. In fact, if you speak a language like Italian or French or German or whatever, maybe you’ve got it made– Europe seems to like US-trained docs and I’ve heard of people migrating over to the Eurozone.

Again, the issue here boils down to one word: Economics. As long as medical residents are seen as a cheap-worker gravy train for the hospitals, the current system won’t change.

the hour change is only part of the problem and i think residencies will adjust. i do foresee further decreases in hours in the future. the problem is not necessarily the number of hours, it is the number of actual procedure time. in the surgical subspecialties, there have been so many advances, that the total number of procedures have increased. surgery is not just an operative field, it is important to have some clinical acumen as well as technical skill. the questions for general programs are what are the general skills you need to be competent surgeon, how many cases should you do to be able to be credentialed to perform that procedure, etc. the numbers of skill set that many in the surgical fields have to learn are just increasing. this is probably why we see so many going into specialties (limits the number of thing you have to be good at).

in orthopaedics, you are expected to be a generalist which requires skill sets in arthroscopy (shoulder and knee), total joint arthroplasty (hip and knee), basic spine (discs and single level fusions), sports (ACLs and non op management), fracture work, hand (excluding replants), basic pediatrics, tumor, shoulder and elbow, and foot and ankle. if you look in the CPT coding there are probably 200-300 different procedures. which are important? how many do you have to do? which re the key procedures? how do you learn to proper patient selection? most of these things in my field can be learned between 7am-6pm M-F.

the outcry i hear in general surgery is about early subspecialization. maybe that is the answer. only time will tell.

ps thanks for the visit.

Extending the surgical training length is really the only option to keep work hours in a safe and reasonable zone. The die-hard surgery residents that wouldn’t have it any other way will continue to train in surgery, but surgery training programs will probably see a decrease in interest across the board for surgical residencies if the number of years for training is increased.