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I agree. If you went to a residency before the time restrictions went into place, you were worked to death. Practice is easy in comparison. In the first ten years of my practice after fellowship, we were on call every third night and usually worked all night. There was no "day off" after call- you just had to work and hope for the end of the day. "Regular days" usually started at 0600 and went to 1900 or 2000. That was tough, but not as hard as residency.
I finished residency 25 years ago and fellowship 23 years ago. A lot has changed (in my opinion for the worse). Keep in mind that with all these restrictions of work hours, residents are being exposed to far less "hands on" experience than they should have. If they are going to cut the hours, then extend the number of years in residency.
The younger docs coming out now are not as well trained as a result and have a hard time adjusting to a "normal" medical work schedule.
Did you walk uphill both ways in blizzards in July to get to your first days of residency too?
I'd like to know how many patients you had in your years of iron man shifts would agree that you are as fully functional as you think you are when you're sleep deprived. Do you think theyll all say "oh I didn't know that doctor was sleep deprived, he didn't mess up anything"
I hear about botched or screwed up operations all the time from patients and old doctors from these "glory days" making mistakes all the time. I see it happen, I'm far from perfect, I'm a lowly mid level, but I've never had a supervising doc that has been perfect either, and most of them are old enough to collect social security.
Providers make mistakes, mistakenly prescribe drugs that have potentially bad interactions, and they can make mistakes in procedures. The only difference between you and these weakling residents you want to bash is that your brain is probably far more capable at this point of performing mental gymnastics to forget about the cases you screwed up when you were sleep deprived.
Drop the ego and focus on the patient well being, not your egotistical boot camp that sacrifices patient well being for doctor
training.
To be fair, I do agree, lengthen a residency out to give more experience but the exhausting hours aren't a learning experience. The only way someone remembers something when they've gone 40 hours without sleep is if they screw something up and the adrenaline rush of fear burns it into their brain.
I see the difference every day. It is not a subtle difference. The residents I train today are not nearly as well prepared. I have 3rd year residents that have a hard time placing a central line. This is something that we had perfected in the first few months of residency. It's easy to sit there and dismiss it as "ego" when you do not see it every day. I don't doubt that mistakes were made in the 40th hour, but I wonder where more mistakes are made? In the 40th hour? Or by docs that are not as well trained?
I see the difference every day. It is not a subtle difference. The residents I train today are not nearly as well prepared. I have 3rd year residents that have a hard time placing a central line. This is something that we had perfected in the first few months of residency. It's easy to sit there and dismiss it as "ego" when you do not see it every day. I don't doubt that mistakes were made in the 40th hour, but I wonder where more mistakes are made? In the 40th hour? Or by docs that are not as well trained?
Would you want to be a patient of a resident who had been on their feet for 36 hours?
Good training and not having people performing medicine when they are so sleep deprived they have the reflexes and mental alacrity of a drunk person are not mutually exclusive.
P.S. - I totally don't doubt your expert viewpoint on this - you're the MD and I'm not - but at the same time couldn't you have a solid training program that didn't put people at that sort of risk? The ability to retain memory declines anyway after that many hours doing something.
Would you want to be a patient of a resident who had been on their feet for 36 hours?
Good training and not having people performing medicine when they are so sleep deprived they have the reflexes and mental alacrity of a drunk person are not mutually exclusive.
P.S. - I totally don't doubt your expert viewpoint on this - you're the MD and I'm not - but at the same time couldn't you have a solid training program that didn't put people at that sort of risk? The ability to retain memory declines anyway after that many hours doing something.
The only solution that might work is to make residency longer, as others have said. That comes with a whole host of problems too. More years of debt forbearance, difficulty finding students willing to sacrifice more years for a career where salaries are declining, etc.
Or interns should be better paid, with benefits, as employees of the hospitals they are working at. The days of independent self employed doctors is over. That creates the burnouts. Internships should be turned around, as paid employment.
Or interns should be better paid, with benefits, as employees of the hospitals they are working at. The days of independent self employed doctors is over. That creates the burnouts. Internships should be turned around, as paid employment.
In the past 3 years, the independent private practice, is the fastest growing segment of healthcare.
Show me the evidence that this actually works on these superbugs in patients who are infected?
I agree with the overprescription of antibiotics, however this is a byproduct of the market. Doctors need patients to return to them when they feel sick, in order to do that they need to meet patient's expectations. The Infectious disease society of America has been fighting with Big Agricultur for some time trying to reduce routine antibiotic use to make livestock grow quicker. Perhaps if we don't want superbugs we need an educated population that understands that antibiotics aren't necessary and may not be helpful all the time. I had 2 patients today I went around with this very topic . I don't think I'll see one of them again. Too many more of those, I might get fired.
Here's some examples to keep in mind:
American association of pediatrics does not recommend initial antibiotics for middle ear infections in patients above 2 years old
The american medical association recommends supportive care for sinus infections, most resolve on their own in the same time with supportive care
Guidelines from the AMA I believe recommend no antibiotics for cases of bronchitis.......
Yet, because of market and business pressures doctors will give antibiotics for all these to keep their patients happy. When what they (the patients) really need is to be told "lets follow up and make sure this doesn't get worse, but your immune system can take care of this on its own and we should save antibiotics for when you really need them."
If antibiotic resistance is really a concern for you, then market pressures need to be removed from medicine, particularly infectious disease. Patient placation is oftentimes bad for public health.
Oh and your little niacin advertisement. Interesting study it cites. Its based on one study done on blood and mice specimens. Not on real people. Who wants to go for that? I support continued studies that could show uses. From a public health perspective I would love to see some alternatives. Not to mention some dosing guidelines because niacin does have toxicities as well. Funny how the advertisement didn't list the niacin toxicities........
Oh, another funny thing, IDSA doesn't recommend antibiotics for your run of the mill MRSA on the skin/soft tissues. Incision and drainage is curative for many of them. Who needs high dose niacin and its side effects? Put a warm compress on it and get the thing drained!! Of course the IDSA must be some evil socialist organization with all their silly guidelines on preventing and treating really nasty infections........
As I recall, you need a doctors supervision for the dosage of B3 they are discussing. Medical research is extremely expensive, and one of the incentives is to make lots of money over and beyond the costs of research. Vitamin supplements are competition for drug companies, they can't patent them, and their not under the FDA YET. But they are working towards that end.
Nothing funny about it.
In the past 3 years, the independent private practice, is the fastest growing segment of healthcare.
Yes. But, from my perspective, the mean age of doctors "burned out" is age 40 to 45. They tried independent practice, got burned out, and are begging for a job with a good pay check, forty hours week, and no administrative hassles. They are going to corporate and federal positions in droves. Places that never got decent doctors have Ivy League doctors, throwing resumes for jobs. It is amazing.
As I recall, you need a doctors supervision for the dosage of B3 they are discussing. Medical research is extremely expensive, and one of the incentives is to make lots of money over and beyond the costs of research. Vitamin supplements are competition for drug companies, they can't patent them, and their not under the FDA YET. But they are working towards that end.
Nothing funny about it.
No, the advertisement linked was funny. It was advertised as "Take our vitamins and MRSA won't get you"and "take our pills and you won't get AIDS or ever need an antibiotic". Nothing more was written, no disclaimers no nothing. Mostly just a money scheme by the vitamin pushers (just as bad as the pill pushers). I laughed with looking at the link, reminded me of this guy:
I recommend going to pubmed and looking for articles involving MRSA and niacin. Not much shows up. So which is what a responsible provider with no financial interest to do? Exprimental treatment? Or well tracked proven to work treatment? Perhaps discuss the risks and benefits of both? Provide the patient with the best information you can and help them to decide if its a responsible choice.
Lots of research is conducted through academic institutions. By students and professors with no financial gain, and B3 is also OTC. Sure you have to take lots of pills, but you can get high doses by going OTC.
Yes. But, from my perspective, the mean age of doctors "burned out" is age 40 to 45. They tried independent practice, got burned out, and are begging for a job with a good pay check, forty hours week, and no administrative hassles. They are going to corporate and federal positions in droves. Places that never got decent doctors have Ivy League doctors, throwing resumes for jobs. It is amazing.
No, they are not going into federal or corporate. They are just getting things rolling, being out of medical schooling only 10 years. That is the residency years... I'd be burnt out too. They partner or open their own private practice, but more than anything, they are going into the veterinarian field, with ease and less stress.
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