Ahh, July 1st.

It came around so fast, just a mere two months of sleeping in and traveling since you walked across that stage with your medical degree in hand. Today’s a new day. Today begins the ritualistic flogging of new interns across the nation.

Waking up at 7am used to seem early, but now it will be considered late.  Weekends will now simply be another work day of another work week. Pimping will take on a whole other meaning now that you have to grin and bear it. Personalities that you thought never existed will be encountered every minute of your existence. While once sacred in your mind, medicine will — at some point — be something that you hate, even for a brief moment.

With the sound of a beeping pager going off somewhere in the background, we welcome you to Hell.

We’re glad you’re here.

Popularity: 7% [?]

The Committee on Optimizing Graduate Medical Trainee Hours and Work Schedules from the Institute of Medicine in Washington, DC is making their final report in nine months and recommend decreasing maximum work hours from 80 to 56 per week. That’s the inside word, anyway.

All I can say is about f’ing time.

It looks like strong support for the care of patients as well as the care of those providing that care is fueling this fire, and I believe the old-schools are probably shaking in their boots right now. This rule change looks to be garnering quite a bit of support.

Additionally, training programs consistently violating the rules as if they’re part of some game probably have a lot to do with the proposed rule changes as well:

Furthermore, we know that despite rules being put in place in 2003 to govern resident work schedules that the culture and traditions remain very strong. What we need are some levers—maybe even some financial levers—to make it easier for people to do the right thing.

Like I said in a post way back — it’s all about the Benjamins. On one hand this could mean yanking funding and even hefty fines (i.e. hundreds of thousands to millions) for training programs that don’t play nice this time around. On the other hand, “levers” could also mean an increase in funding to those programs who are rule-abiding citizens. Either way, it’s about f’ing time.

The primary task of this committee will be to focus on four areas:

• Synthesis of the current evidence base on graduate medical trainees hours and works schedules and their impact on safety.
• Identification and development of strategies, practices, interventions, and tools that can be used to implement reasonable work hours.
• Analysis of both the potential benefits and harms of updating work hours and schedules.
• Short- and long-term recommendations for action by various stakeholders and interim strategies and policies for implementing these recommendations.

According to the thread at SDN, the only problem yet to be tackled is length of training. But, it’s a big one.

I’d say that many people are willing to put up with the extra-long work hours in order to be done with an Internal Medicine residency (for example) in three years. However, there are undoubtedly countless others who would prefer to live a more “normal” state of being and extend training by a year or two.

I guess it really all boils down to how much you really want it, but I see this coming out into the light sooner rather than later. No matter how you slice it, “only” 80 hours per week is the biggest joke I’ve seen in a long damn time.

Popularity: 15% [?]

“What’s a Golden Weekend?” you ask. Let’s play a game.

• It consists of 48 hours of time away from work.
• Saturday and Sunday are the typical days included in the Golden Weekend.
• Many people look forward to the Golden Weekend all week long, every week.
• Medical students and residents look forward to — and receive — the Golden Weekend only once per month, on average.
• A Golden Weekend is a weekend that most “regular people” experience, on average, four times per month.
• The Golden Weekend can be used for short-term travel, bar-hopping, hiking, or just lounging around the house and sleeping.

Give up?

The “Golden Weekend” is a term coined by residents. It typically refers to the weekend in which you have both Saturday and Sunday free from all clinical duties. Since many residents only get one weekend per month completely free from the hospital, the term is derived from the notion that “it feels golden to have your entire weekend off.”

Only in medicine.

Popularity: 8% [?]

Even though residency working conditions have nothing to do with me on a personal level, I am a huge, huge advocate for residency work hour reform.

There’s a really simple and free way for you to support work hour reform as well — simply place a link on your blog to HoursWatch.

Hours Watch is dedicated to ending excessive work hours for medical residents, and finding solutions that enhance patient care and residency education. Hours Watch is jointly sponsored by the Committee of Interns and Residents, and the American Medical Student Association, organizations that have led the fight to reduce unsafe and unhealthy overwork of medical trainees.

Although CIR and AMSA view the ACGME’s move to regulate work hours as a major step toward safer and more humane medical training, there is also reason for skepticism that an industry-dominated accreditation group can effectively enforce its own rules or provide adequate protection to residents who blow the whistle on violations within their training programs. Therefore, one goal of Hours Watch is to serve as an independent “watchdog,” monitoring and lobbying for enforcement mechanisms that offer better protections to residents.

Just a simple link back from your blog will increase exposure to the cause. Great examples of links are:

• HoursWatch
• I support work-hour reform
• End residency slave-labor
• Residents are indentured servants

Popularity: 4% [?]

It’s true, and is published in a recent NEJM article.

Residents in Europe work about 56 hours per week, and after August 2008, they will be allowed to work only 48 hours.

Sleep medicine experts state that current training restrictions with maximum 30-hour shifts and 80-hour workweeks are unsafe for both patients and physicians. A fine balance is being looked at as to where the optimal line of patient care vs. physician work hours can be drawn.

If you compare what US residents work to residents in Europe, the poor US guys and gals are working almost twice as much.

I think further work hour reform is on the horizon, especially if favorable data comes out of the decreased work hours for European residents. Only time will tell but I think it’s a push in the right direction. 80 hours per week is still too damn much.

Via: [NEJM]

Popularity: 5% [?]