Because I was at the hospital late this afternoon (late as in, past civilian office hours), I got to see a complication in a patient our service operated on earlier in the month. It was the first time I’d ever seen or heard of, and it was a great experience to figure out what it was and then call the chief and treat it in the ER with him. Because we sent the patient straight home, the team members who weren’t in the hospital that late will never see it, and if things get busy this weekend, they may never even hear what happened.

There’s a rumor floating around that the ACGME (bureaucratic organization that regulates all residency programs) may be looking at imposing 60hrs/week rules. I sincerely hope that this is an urban legend, since I haven’t had anyone close to a program director verify it yet. . . but given the number of insane, counterproductive things that the government and other agencies are doing to the healthcare system, I could believe it.

All I can say is, I hope they wait till I finish residency to do that. If not, I think I would finally have a chance to practice civil disobedience, as I have always longed to, and flagrantly disobey the rules.

We barely have enough time right now. I know the chiefs who are graduating this year have expressed a great deal of angst about being the first class to go through completely under the 80hr rules. They have no idea how their skills will match up to the real world in July. They’ve said things about having less experience over all, feeling less confident than they think their predecessors a few years ago did. Maybe it’s just the usual nervousness before taking another big step. . . but maybe they’re on to something.

I can not imagine what we would do with further hour restrictions. We’re already limited to 12hr shifts. The only way to cut time down further would be to move to 8hr shifts – and then 2/3s of the residents (afternoon and evening shifts) would be simply wasting their time, being present in the hospital purely for coverage reasons, and the occasional emergency surgery, since most of the surgery action happens in the morning and early afternoon.

There’s a physical impossibility in here: surgeons do most of the things that medical doctors do – admit patients, round on them, order and evaluate tests, discuss the results and plans as a team – and in addition, we have a whole ‘nother day’s worth of work to do, in the OR. Doing 2x or 1.5x as much work as another specialist would do simply takes more time. I suppose we could also not round on patients before surgery, just catch up on them piecemeal between cases. But considering how many near-disasters have been staved off during morning pre-rounds, I can only conclude that patient care would suffer abysmally from such a change.

Somebody keep the ACGME tied up with some paperwork for the next 4 years, please.