Dr. Centor summarizes a bunch of internists talking about the current state of residents and thoughts on work hours, but in my perspective leaves a number of things out:
- No offense to the old school, but medicine today is a lot more complex than it was even 10 years ago. I’m not saying that residency was any easier, but there’s simply much more knowledge, information, data, treatments, diagnoses, studies, and procedures that we have today than we did previously. And residents (and medical students) are expected to know them all. Granted we have better technologies to make us more efficient (12 lead EKGs with rhythm strips and telemetry and not having to use suction cups, and computers that spit out lab values, and electronic medical records and digital imaging), but medical school is still 4 years long, and most residency programs haven’t changed in length, either. In the same amount of training time, we’re pimped on which genes are involved in which diseases, expected to keep up with all the new data and trials that are constantly being published, as well as know how to appropriately use new medications, titrate them, and anticipate their possible side effects. We have to be able to do basic reads of CT scans and other imaging. It is a lot to learn. (And at the same time, we can now sustain patients and keep them alive longer, and there’s all the ethical issues that now come along with that as well.)
- Let’s say my generation does want a better balance of personal and professional life. (Just hypothesizing for now.) Can you blame us? We’re working just as hard as you old schoolers did in medical school and residency, but our average debt is so much higher! Many of us have also grown up (not me, fortunately) with parents and families who developed their professional lives at the expense of their personal and family lives, and it ended in divorce, frustration, or unhappiness–and we don’t want to repeat the mistake ourselves. And honestly, do you want an unhappy, jaded physician treating you, anyway? (Medical students are on average older now than they used to be, which also leaves fewer years to have a family or develop relationships.)
- The 80-hour work week, just like everything else, has its pros and cons–no doubt about it. But who would you want writing your orders, if you came into the ER with chest pain. The groggy resident who’s running on empty, who might just forget the heparin, or might miss subtle ST depressions or elevations?
- Or perhaps we’re just an egotistical, self-centered generation who require praise at every turn and who care more about our own happiness than our patients’ lives. (If you’ve met any of my classmates and seen their accomplishments or how they talk about their patients, I’d find this hard to believe.) But why else might our supposed “work ethic” have changed? Could it be the change in the practice of medicine? From an art and a practice to a business? From calling the preson you’re treating “your patient” to “your consumer” or “your client?” From focusing on what’s best for the patient to what’s best “medico-legally” as well?
Just some random opinions, devils’ advocacies, and thoughts.