Whether you want to believe it or not, many training programs are in violation of the ACGME duty-hour standards. I’ve known this all along, primarily from talking with many people in residency that I keep in touch with on a regular basis.

The AMA has released a study that basically proves that the work hour standards are one big piece of political bullshit.

The study was a monthly web-based survey, and polled residents preimplementation and postimplementation of the work hour standards. The residents taking part in the survey completed 29,477 reports of their work and sleep hours.

Violations were reported during 3765 (44.0%; 95% CI, 43.0%-45.1%) of the 8553 intern-months assessed postimplementation (including vacation and ambulatory rotations), and during 2660 (61.5%; 95% CI, 60.0%-62.9%) of 4327 intern-months during which interns worked exclusively in inpatient settings.

There you have it, folks. Nearly half of all months had violations during ambulatory settings and nearly 62% of months had violations where interns were working on inpatient services.

The ACGME needs to start cracking some balls if they want programs to take these duty restrictions seriously. If nothing is done, or programs are simply slapped on the wrist, the system will continue to be abused and work hour restrictions will be nothing more than fudged numbers on some slip of paper in the program director’s office.

via: [JAMA]

I read through a very interesting post tonight at SDN where the OP asked the question of whether or not he should finish his last few months of prelim year in medicine now that he has matched into a pathology spot for 2007.

Most of the early replies are “stick it out” and “don’t quit.”

Kimberly Cox then posted what happened when a similar situation happened at her program.

We had a Prelim resident who did the same – basically got a position in the scramble and called and said she would not be coming in again. Not only did that upset everyone (adding to their call schedule), it was unprofessional…our PD made sure her new PD knew about what he was getting.

Wow. You know, that PD is an asshole.

Private companies aren’t allowed to release information on why employees left a previous job unless gross misconduct or illegal activity was involved. That’s the problem. Residency programs can do whatever the hell they want to because there is no free market competition. Adam_K sums it up nicely.

If residents could freely transfer over to new training programs that offer better pay and working conditions, this behavior wouldn’t exist. Program directors would be kissing ass instead of overworking and over scheduling to make up for deficiencies in staffing that should have been factored into the system to begin with.

What happens, though? Programs operate with the bare minimum number of residents. If one quits or doesn’t show up, the workload is transferred over to the other residents. They have to pick up more hours, more call, and more patients to make up for a missing body.

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Most students go to medical school because they want to care for patients in the traditional sense. This includes physical exams, following up on labs, making treatment decisions, and a whole lot more.

Unfortunately, most medical schools don’t promote Pathology as much as they should. It’s not part of the core rotation curriculum during your junior year, and if you want to see what a pathologist actually does, you’ll need to set a block of time aside for an elective rotation as a senior student. Despite this, I do think that people are catching on.

If you haven’t given pathology some serious consideration, here is why you should:

1. No Patient Contact

You get to work with people, it’s just that they are other doctors. You are the “doctor’s doctor.” There is no rounding, no morning CBC to follow up on, no SOAP notes, and no physical exams at 5:30 am. Pages from the nursing staff are eliminated. Did that chest X-ray not get done this morning even though it was written for? Not your problem.

2. Good Hours During Residency

You can sit back and really appreciate a normal work day even during residency in most pathology training programs. As Panda Bear mentions, pathology comes very close to 40 hour work weeks even during training. Outside of dermatology and perhaps opthalmology, this is pretty hard to come by.

3. The Money Is Great

Pathologists get paid extremely well, especially considering the amount of time that they work. Salary data is from the Modern Healthcare Physician Compensation Review [PDF], and includes several data sources per specialty. According to the image to your right, the average annual salary for pathology is $254,398.

4. Almost No Call

What little call you’ll experience in pathology can all be done from home. I’ve never talked to any pathology attending or resident who has to take in-house call. The work just doesn’t require it. The dreaded “q3 call” won’t even be in your vocabulary, and you’ll cringe as you see residents in other specialties getting killed by a brutal call schedule.

5. Laid Back Work

Where else can you spend every other day or so with a nice cup of coffee getting your work done as you look into a microscope? Need to look something up or do some reading? You have time. None of the residents in pathology that I’ve ever spoken to relayed any feelings of being “rushed” or “not having enough time to complete work.” The work is laid back, and so are the people that go into pathology to begin with.

Don’t Give In To Stereotypes

I think too many medical students see pathology as a “weird” specialty. Students have been stereotyping specialties ever since they began medical school. As mentioned earlier, students don’t see pathology for what it is, but instead look at it as “nontraditional medicine.”

Don’t give in to these stereotypes and feel that you have to practice traditional medicine in order to be a physician. See specialties for what they are, and realize that you too can have a good life.

Don’t always try to read between the lines. The writing is on the wall.

I just learned that the 2007 match was the largest in the history of the NRMP [PDF]. All of the information can be found in the Advance Data Tables for 2007 Main Residency Match [PDF].

6.6% of US Medical Seniors went unmatched for the 2007 year, up from 6.3% the year before.

There’s a wealth of information from each specialty, so check it out.

Simple graph that gives you a somewhat updated feel of where students are focusing in terms of specialty.

Percent Change between 1998 and 2006 in the Percentage of U.S. Medical School Graduates Filling Residency Positions in Various Specialties.
National Resident Matching Program

I was surprised to see Anesthesiology so popular (I knew it was popular, but it killed everything else), but not surprised at all at where Pathology ranks. Pathology is an excellent lifestyle specialty and is completely underrated. My prediction over the next several years is that Pathology is going to continue to get more competitive while interest in Anesthesia will taper off.

To whoever it was that disagreed with me, it looks like interest in surgery is in fact declining.

via: [SDN]