Duty Hours As A Weapon Part 2

 

By:  The Generation Y Surgeon (@GenYSurgeon)

 

Using the Duty Hours as a Weapon Part II: The Devaluation of Residency

In my last post I highlighted how residents have learned to use the duty hours as a weapon against their program, peers and attendings.  I also pointed out that this is NOT professional (one of our core competencies!); however, residents aren’t the only offenders.  In this post I’m looking at the other edge of the sword–how senior physicians use the hours against residents.

 

We have all heard the stories of the olden days….when surgeons were lucky to walk to the hospital uphill both ways because that meant they were allowed to leave.  When residents were called residents because the actually resided in the hospital.  When doctors worked 1000 hours a week and were treated like gods by nurses and patients alike…

 

Those days are over.

 

The 80 Hours Is A Double Edged Sword For Residents

Ever since the start of the 80-hour workweek, residents have found themselves in the middle of a no-win situation.  If you log violations or get caught lying your program could get shut down.  If you go home like you’re supposed to, attendings are annoyed that you’re unavailable.  Making the schedules for case coverage, rounding and calls has turned from a chore into a nightmare.  And at the end of the week, you’ve still only worked 80 hours.  Eighty hours is a long time–it keeps you from having a social life, from your family, and from your significant others…but to the people you work for it means next to nothing.

 

The constant backhanded insults from senior physicians regarding duty hours are demeaning and they strip all the pride out of being a general surgery resident.  No matter how hard you work (or not), at the end of the week someone tells you that there’s no way you’ll live up to their standards, match their commitment or otherwise end residency as a fully trained surgeon.  It’s demotivating and demeaning.  No wonder residents do their best to get out of the hospital.  When you take away the pride associated with working hard and sacrificing your personal life for your work, what’s left?

 

As Millenials, Our Generation Didn’t Cause This…But We Take The Brunt Of It

Using the duty hours as a psychological weapon against the residents is unfair because the current generation had nothing to do with WHY they were instituted in the first place.  We were all in diapers when our profession let training standards dip to the low point where patients were endangered or where the public thought they were endangered.  A profession is a self-governing and autonomous group, and part of that means that we create a sustainable culture and work force that is safe for us and for our patients alike.  You can accuse the government or media all you want of spinning the issue, but regardless of why or how people felt physicians working 120+ hours a week was anything but safe and sustainable.  The profession had not self-regulated prior to the storm breaking.

 

Unfortunately it took a highly publicized patient issue (not to mention many others that were not publicized!) to establish the hours restrictions.  We should be ashamed of ourselves as surgeons and physicians that we let things get to that point in the first place.  A profession, by the true definition of the word, would have had the foresight and discipline to institute effective changes before these disasters occurred.

 

It Wasn’t The Younger Generation That Failed 

So when you when you find yourself using the duty hours as a weapon, whether on purpose or inadvertently, remember that it wasn’t the younger generation that failed.  How we got to the need for resident work hours was a failure of Surgery as a profession in its entirety.  Don’t just complain about the work hours–help to build and develop them.  We as surgeons, and as professionals, need to evolve and adapt or we too will go the way of the dinosaur.

 

Any feedback?  Let me know beneath!

 

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