Wednesday, January 02, 2008


I have not done anything terribly exciting--as I currently am on a month off I have pretty much been relaxing continuously. I have been trying to read from Sabiston or from surgery journals a couple times a week to keep from completely vegging out. I found one very interesting article looking at the attrition rate in surgical residencies two years before and two years after the installation of the 80 hour work week (before a few years ago there were no work restrictions for residents so it was commonplace for surgery residents to work 100-120 hours every week, and be on call every other day--now residents cannot work more than 80 hours/week or their program can be put on probation [interestingly I just read that residents will be limited to 48 hrs/wk in the UK starting in 2009--I find that kind of scary]). Surgery residencies have traditionally had a pretty high voluntary drop-out rate of about 20%--residents tend to leave for more lifestyle-friendly residencies such as anesthesiology, emergency medicine, or family medicine. One would thus think that the attrition rate would decrease now that work hours are restricted. Surprisingly the rate has actually increased--the study I read showed the the typical surgery program lost 0.6 residents per year before the 80 hour work week, but now the typical program loses 0.8 residents per year. Granted this study only looked at a period of four years, and most likely the programs were not as compliant with the 80 hour work week two years after its installation as they are now, but I thought it intriguing nonetheless. The authors' hypothesis was that people who previously would not have applied to surgery due to its lifestyle thought that with the 80 hour work week residency would be more manageable--only to find out once they started that even with only 80 hours/week it was still quite rigorous.


Anonymous Anonymous said...

I think you have as good an explanation as any. I haven't noticed anyone leaving my program, so I'm a little puzzled by an attrition rate that comes close to one resident leaving every year, which I would expect to have witnessed by now.

But as for why: even with work hour rules, surgery is still much more intense than other specialties. A medicine friend was talking about having asked his senior to look through some charts and do scut work (call in prescriptions), which the senior did. I and the other surgery intern were horrified. We would never ask, and our seniors would never encourage such "weak" behavior. The rules haven't changed the basic culture.

4:21 PM  
Blogger Chris Emlyn said...

The different culture of each specialty is very interesting--on my peds sub-i we had a new critical care attending every week. Midway through one week I had two senior residents sit down (one with me and one with the whole team of students and interns) and warn us that the incoming attending had a reputation as a very harsh/malignant physician and we needed to make sure that we knew every little detail of our patients and didn't waste any time in our presentations. I was a little intimidated, and particularly dreading it because I was on call the whole weekend. He came on and I thought he was great--he wasn't particularly friendly, but he never berated anyone and made an effort to teach.

4:55 PM  

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