Thursday, June 15, 2017

Surgical residents have lots of problems, need more time off

A recent survey of surgical residents regarding their personal and professional well-being revealed that while most of them enjoyed going to work, they had many serious issues.

All 19 surgical residency programs in the New England region were invited to participate, and 10 did so. Of 363 trainees contacted, 166 (44.9%) responded to the survey with 54% of respondents saying they lacked time for basic health maintenance. For example, 56% did not have a primary care physician and were "not up to date with routine age-appropriate health maintenance such as a general physical examination, laboratory work, or a gynecologic examination."

I am not surprised that young men and women averaging 30 years of age or less have no primary care physician? I wonder what percentage of young people who are not surgical residents have one.

Should asymptomatic people in this age group or anyone in any age group have a general physical examination and lab work?

Residents are sleepy. The average score for residents on the Epworth Sleepiness Scale [ESS] was 14 indicating moderate daytime sleepiness. 

And many have a lot of plaque. About 43% did not "have a relationship [I assume meaning professional] with a dentist or dental hygienist," and 37% had not been to a dentist's office in over two years.

According to the ACGME Common Program Requirements, a resident must have a minimum of one day off per week averaged over four weeks and minimum of 14 hours off after each 24 hours of on-call duty. How is it possible they have no time to sleep or go to the doctor or dentist? What are they doing during their off time?

A 2012 paper from the ACGME explored that subject by surveying 636 first and second year residents from medicine, surgery, pediatrics, and OB/GYN. The authors found that residents slept an average of 42.6 to 45.4 hours per week or 6 hours per night and their ESS scores were 9.9 to 12.3 signifying mild daytime sleepiness. This figure shows how they spent their waking hours when off duty.
Click on figure to enlarge it.
Just over 83% of respondents to the well-being survey said “the demands of their job interfered with their ability to take care of personal matters, including but not limited to health and exercise, finance, and personal relationships.” Can’t they find an hour to get their teeth cleaned? Why not exercise while watching TV?

That paper’s authors have changed the culture of their program to allow residents “to occasionally take time out of the workday to accomplish the basic tasks of self-care.” No comment.

Finally, 92% reported that being a surgical resident caused at least moderate (77%) to severe (15%) stress.

I’ve said this before, but it bears repeating. If you think the stress of being a surgical resident is bad, wait until you become an attending surgeon and are responsible for everything that happens to your patients. And being an attending surgeon will interfere with many activities not limited to those mentioned above.

Thanks to @JWill_PediACCM for sending me a link to the paper about what residents do when they are not working.


George Gasman said...

1) "The problem with being on call every other night is that you miss half the good cases."

2) There's a reason they were called "residents," back then, instead of "trainees."

3) And, yes, the stress of becoming an attending...I had occasion to take care of the same patient on the last day of my fellowship, who returned for *another* operation on my first day as an attending at a teaching hospital. I had to deal with residents.

4) Your life is not your own. You signed up for that, and you should be cognizant of that. It's only now, having been chained to being within 15 minutes of the hospital for 3/5 nights for 25 years, being retired, that I understand and appreciate what "me time" is.

5) *I* sleep about 6 hours a night. Even to this day.

Skeptical Scalpel said...

Stand by for the comments calling us old fossils or worse. I too average 6 hours of sleep per night and still wake up at 4:30 or 5 am and I've been retired for almost 5 years.

Anonymous said...

Having completed an otolaryngology residency 2 years ago, I can absolutely agree that the stresses on this side are greater, but the time demands are clearly less. First, those 80 hour work weeks took a fair bit of 'massaging' to stay within the rules (there were many call nights that, according to my duty hour logs, I "left the hospital" at midnight), and second, how many dentists do you know that have office hours on Sundays?

BlackSails said...

I mean having 1 day off in 7 doesnt mean you can see the dentist. Few dentists are open weekends. The only reason I have been able to see a primary care doctor is that one of our outpatient clinics is in the same building as the main hospital and she was willing to stay late to see me.

I dont complain about this, but saying that since we have 1 day a week off we can do all these things is incorrect.

George Gasman said...

"Stand by for the comments calling us old fossils or worse."

Of course. About 3 years ago, I was doing a c-section with an OB friend of mine. It was 2 AM, and the family practice resident...I mean trainee...was talking about how hard it was to be on call every 4th night away from her family, and how thrilled she was that this was her last night on call in the hospital forever.

Well, needless to say, Jack and I rolled eyes at each other.

Oh, and "the job interferes with their ability to take care of personal matters, including but not limited to health and exercise, finance, and personal relationships."


As a 1st year resident, I was on call on Friday, got married on Sunday, and was on call the next Monday. That marriage, by the way, celebrated its 40th anniversary last week.

I have zero sympathy, fossil that I am.

Anonymous said...

I'm bucking it here by saying THANK YOU to all the "old fossils".

Second ... gotta agree with Skep on brushing your teeth, etc. instead of surfing the internet. The younger generation ... ;)

Skeptical Scalpel said...

Thanks for the comments.

Re going to the dentist. I know they aren't open on Sundays. If it's impossible to see a dentist tell me how 57% of those responding had a relationship with a dentist or hygienist and 63% had managed to get to a dentist within the previous two years?

George, I can't disagree. Anon from 7:53, not sure if you're kidding but I'll take it as a compliment.

Anonymous said...

Allow me to play the devil's advocate.

Residents anymore have less clout than the nurses and the scrub techs. Everyone is an equal member of the "provider" team until there is a problem, and then you know who stays late to deal with it. Every year our clout, salaries, and autonomy falls. Fortunately, it is compensated by a never ending increase in bullshit paperwork, new "policies" that make no sense, and all such garbage. The surgeons' time, and this applies to the attendings as well, is wasted without a second thought because it literally has no value. We don't get paid overtime, after all. I respect and agree with the concerns of the old guard, that we are losing our professionalism and aren't taking the ownership and responsibility that our job requires. But I would argue that my generation isn't happy with those changes, we are being smothered into this new role by the ever increasing power of faceless administrators who have no clinical experience whatsoever. These changes, which have been occurring over the past 10-20 years as best I can tell, have taken place in the context of a near complete abdication of leadership on the part of the 'old guard'. You were too busy to govern and police yourselves, and now it will be done for us. I think we should hesitate before judging an entire generation of surgeons who set out to work hard and take care of patients, although maybe not to be martyrs.

artiger said...

Anon at 10:22pm raises fair points. As someone too old to have enjoyed work hour limits yet too young to qualify for the Fossil Club, I'd like to point out two things:

1) Every generation of physicians has it much worse than those following them.

2) Is it not a primary goal for advances and research that life will be better and easier for the generations that follow?

Skeptical Scalpel said...

Agree that Anon at 10:22 made some great points.

I refuse to accept responsibility for the current state of affairs. In real life I tried to be a voice of reason and no BS in several organizations especially the Association of Program Directors in Surgery and the American Board of Surgery. I was continually rebuffed.

One of the reasons I started blogging anonymously was to voice my opinions freely. So far it has worked.

Now both the ABS and the American College of Surgeons follow me on Twitter. But it's too late to change the way things have evolved. As I say to myself almost every day, "I'm glad I'm retired."

Anonymous said...

Anonymous Europe: I guess I am in a special case because as a med student I saw the "good old days", and am active now. Bureocracy has become overwhelming and you could spend a whole day filling out papers instead of doing operations.... Besides patients (or their parents/family members) have gotten a lot more demanding and aggressive, wanting to sue you for everything... Besides the whole world has sped up and in this acceleration there is hardly any time left for training us youngsters properly. We get pushed into the outpatient units or have to do the ward's paperwork... And we get to go more less into the OR than the trainees in the good old days.

On the case of free time: My generation did not know his/her own father, because he was always working... Besides our mothers hardly met our fathers because of this. No modern girl/lady would tolerate this. We would like to be there when our kids grow up and spend time with our significant other and respective families. I do not live to work, but rather, I work to live. Why would I work in the first place if I do not get to spend the money I earn??? (not meaning Iphones, clothes and meaningless things, but travels, courses and a house maybe)

What really disdains me is, that in this survey most of the free time spent was using the internet, which just shows how screwed my generation is. If I have two extra hours, I would rather devote it to my significant other/family, go budybuilding or read a book, than surf the net... Besides if I die I will not remember how much I worked, but rather the time spent with love ones, doing hobbies and stuff.
Sorry if I was somewhat of a shock for some people, just thought I would show you guys my point of view.

Skeptical Scalpel said...

Europe, thanks for commenting. I had that same thought about the Internet time.

Oldfoolrn said...

You folks are surgeons-the apex predators of the hospital, tip top of the food chain. You can easily learn enough basic dental skills to care for your own teeth. Purchase a few dental picks, a mirror, and an explorer. Ask a dental student to show you how to do a prophy. I do almost all of my own dentistry and have every tooth that I was born with and they work like new after 7 decades of chewing various foodsuffs.

If you are a surgeon-you can do just about anything better than anyone else, at least that's what the docs I scrubbed for thought.

Skeptical Scalpel said...

Old, I appreciate your confidence in our skills, but I leave the teeth cleaning to my hygienist with whom I have a professional relationship.

William Reichert said...

Speaking of overworked surgeons, how about this for overworking?

Anyone ever seen this stuff?

TheMillenniumIntern said...

I would like to point out that my generation does everything online - use the net for me includes paying my student loans, buying groceries, ordering flowers for Mother's Day etc.

Skeptical Scalpel said...

William, the type of overworking you linked to is voluntary.

Millennium intern, I understand that. You might be surprised to know that many of us old-timers do the same. My point was that there seems to be time to do a lot of things when not working.

I find it interesting that although one cannot get one's teeth cleaned online (yet), the majority of residents managed to found the time to get it done.

frankbill said...

I think the link would have made a good M*A*S*H episode.

Post a Comment

Note: Only a member of this blog may post a comment.