Uh is training a resident really that expensive? At what point are they just getting money back from not having to hire mid levels.

Is there a way to know that?

Why do some countries still have strong diglossia patterns and why did some (like chinese) never develope a phonetic skript to replace the old scripture?

Hold it. I wish there were any other solution. Desperately hope the OB person isn't busy and can come down and break you for 5 min but they're usually busy. Your bowel habits adjust honestly.

But why can't you do them in such a way that you got 2 surgeons working at the same time, each with 8 hour shifts but which start 4 hours apart. So you got 4 hours working at the same time, but after 4 hours one of them is changed. After another for hours one who has not yet changed is changed. Every time one who has been working longer is the primary surgeon at the moment, other assists.

That way you got 4 hours of time to get in touch with current state of the operation.

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That's the only reasonable alternative in your mind, which does not surprise me. Except, it is possible to train physicians without significant quality difference, with less exploitative working conditions in the same amount of time. AND there are fewer medical errors.

To me, it is truly laughable that you consider it a privilege that residents are paid to be trained when you calculate how much they bring in as revenue and quality of life for the graduated physicians. Admittedly, I don't know much about the numbers in your country, to that regard.

Similar to the treatment of Ignaz Semmelweis when he discovered washing hands saved lives, today's medical world ignores the facts that sleep deprivation causes mistakes which results in patient deaths.

The profession prides itself on working long hours even though evidence shows sleep deprivation is equal to or worse than being drunk. Pilots, truck drivers, air traffic controllers all work under regulated hours, but the medical world's hubris blinds them into believing they are impervious and the exception.

Medical error is estimated to be the 3rd leading cause of death in the US leading to 250,000 deaths each year. It's unconscionable that the profession does not take proactive steps to minimize these errors by starting with the elimination of sleep deprivation.

The model of working longs hours in residency was promoted by Dr. William Halstead, a cocaine addict, who expected his residents to be on-call 362 days a year and handle a workload that was difficult to maintain without artificial stimulants. It's a deadly rite of passage that continues today.

I haven't even mentioned the effects on residents and doctors themselves. Many residents and doctors commit suicide because of sleep deprivation or in the very least, develop mental illness. And guess what? Seeking mental help in the medical world is frowned upon; especially for students. Mental illness among the ranks is a mark of disgrace. The medical profession disregarding the Hippocratic Oath for their own is one of the worst ironic hypocrisies in the modern world.

Economics. We claim to be a “free market” economy but don’t question FED setting rates instead of market forces. Why is money different than shoes or bread?

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A scrub is a guy who can’t get no love from me, hangin out the passenger side of his best friend’s ride tryin’ to holla at me.

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yeah you either have to reduce the onions first, or not cook them at all

Less work hours means less exposure to learning cases. End of story.

Also, residents certainly do a lot of work. But every decision they make needs to be supervised by an attending. A private practice attending often can do the work a team of residents does at a training facility. I really don't think they're grossly underpaid. Maybe somewhat, but it isn't like they're working in sweatshops. And, at the end of the day, they are being paid to be trained. It costs serious money to train a resident.

I'm all for more rest and free time if the number of years of training is increased to compensate the loss of experience.

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I cannot imagine a continuous procedure that takes 36 hours to complete. What exactly are they cutting for such a long time?

If this is about making extremely delicate incisions in the brain of the patient or something like that, I cannot imagine that a surgeon who has been working for 35 hours and probably was already sleep-deprived when they started will do the best possible job.

Just seems very likely to me that handing over to a rested person after 12 hours or so, when some kind of milestone has been reached, would lead to better results for everyone involved.

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Do you really believe this, or have you gotten used to hearing and/or making up these excuses. If you looked at how other countries train their physicians, you would know this is not true. I mean, just by reading this, I know what country you work in, doesn't that mean something to you?

Residents are needed to keep continuity of care, and they are cheap and profitable. There's also no good reason they can't be paid more... You act as if wanting more money and less work/hours is in any way a bad thing. But clearly, because of people and a mindset like you, this is neigh unchangeable.

Just stop pretending it's a good thing that people are getting used like this.

More rest and free time add to better learning.

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I work at an academic hospital with a cardiothoracic surgery training program.

Depending on the case, the attending does not always need to be present the entire time. A routine aortic valve replacement, for example, has multiple steps, some of which are more critical than others. Once anesthesia has the patient asleep, a senior CTS resident or fellow should be perfectly capable of cutting through the sternum with a bone saw and incising through the pericardium to expose the heart and great vessels. Once the attending surgeon arrives, the resident will place+connect the cannulas for cardiopulmonary bypass, and the perfusionist will deliver cardioplegia (to arrest the heart) and begin the pump run. The surgeon then joins the case hands-on for the team to perform the critical incisions on the heart and aorta. For more complex operations, sometimes the attending will call for another attending to join the case (for example one surgeon may be comfortable with the aortic valve, but may call a colleague to help if the patient needs a mitral repair or a septal myectomy). Once the aortic valve prosthesis is in place and the heart is stitched up, the team will return the blood from the cardiopulmonary bypass circuit reservoir, restart the heart, and ensure the heart has restarted in stable condition - the anesthesiologist will look with a transesophageal echo probe to see if there are any problems. If everything looks okay, the attending will leave and the resident (maybe a different resident if the first one had to leave) will wrap up, close the pericardium, close the chest, and suture up the incisions.

So the case is done in continuity, but the attending surgeon only really needs to be there for the critical part of the case. What’s “critical” vs. what’s not depends on the case, of course, and if there is significant troubleshooting because something goes wrong then that obviously requires a longer time.

TL;DR people rotate in and out of the operation to execute their particular roles when they are indicated. Not sure how it works in other specialties but I bet it’s something similar.

You're on the right track, I'd say! It's all a matter of personal taste IMO but I like my onions either cold and raw or caramelized dark/poached in wine or something

Perhaps in the long term, but not necessarily in the short term. The process of medical school accreditation is separate from the number of residency slots, increasing program sizes, or creating new residency programs.

There are still MDs who go unmatched into programs and the job market for general practice without being board certified is very limited. I think it’s pretty illogical that in many states midlevels (usually NPs) can gain fully independent practice (FPA) shortly after graduating while physicians cannot (licenses require 1-2 yrs of residency training before you qualify for licensure).
A lot of this comes down to lobbying, unfortunately.

Absolutely. Much greater risk of contamination by having a surgeon scrub out and back in, open doors, etc.

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