Damn misfit, how am I supposed to be a crotchety old man when you are so polite? 😉
I think you guys are seeing only one side of the issue. You need to give you fellow medical students and other residents some credit. it is not just because they are sheeple that they do the long shifts. There are good reasons why residency can be so time intensive. No doubt much of it has degenerated to hazing and regimentation, but even the "unnecessary garbage", Prolene, are critical to patient care. Seeing a CT as it comes out with the radiologist is a learning experience. Doing your own blood smears can also be instructive. Not all the time, but don't be too dismissive.
Residency is a social activity steeped in tradition. It has good and bad. The long hours aren't entirely arbitrary, nor is it possible simply because current students and residents (who have very little power, mind you, put up with it.
The following is something I wrote to explain to some military guys why residency is, in their words, a suckfest. I hope it presents a bit of the other side. I think change was and is necessary, but the system was the way it was for some some good reasons. Somewhere along the way we became just cheap labor, and much of the apprenticeship aspect of actually being taught was lost. I blame medical education leaders and attendings for this, and think the solution still lies there. Anyway, it's long, but read the info below and try not to be too judgemental of your fellow students, everyone.
The gruelfest, as you and Col. XXXXXX noted, is similar to Ranger training in certain cultural aspects. It is partially tradition, partially hazing, partially good training technique, and partially economics.
Halstead, the father of American surgery residency training, learned much from the Prussian military hospital system. To a certain extent he recognized that strict hierarchy and discipline in an extremely limited (in the days before reliable anesthesia) field that required a good deal of brutality and a certain ruthlessness, required a rigid social structure to maintain order. Many of his practices still form the basis of all residency training. Medicine being a conservative (some would say clannish) profession, these attitudes persist.
These social conditions tend to attract some very controlling personalities, and thus tradition evolves easily into hazing, or at least an attitude of "I went through it, you do it too." And it is bad form if a patient is suffering and a senior attending is trying to teach you, if you say "Well, it's 5 o'clock. I'm going home because my shift is over." An ambitious or caring young doctor would never do that. Before the days of evidence based medicine and medical imaging, and even long after it, the clannish approach of imparting medical knowledge at the bedside, learning as an apprentice to the master, was seen (and is still seen sometimes) as the best way to learn. Much of common practice is now being questioned as people use large studies to evaluate treatment decisions, rather than the usual standard of "Well, my Chief resident did it this way, so it's good enough for me." Woe betide anyone who questions the Gods of Medicine and the word from on high!
Fortunately, much of the foolish and malignant aspects of residency training are passing on. In most residencies people recognize that treating educated, caring adults as human beings is a good idea. Also, most doctors do not need to deal with dire emergencies, and so long as they recognize that a patient needs acute help, they can send an ambulance and enlist the aid of experts. So a reasonable exposure to exhaustion and emergent cases is sufficient.
Surgery is a bit different because the act of treatment itself is a brutal assault on the body. I have to make you unconcious, suspend your ability to breathe for yourself, cut you open with a scalpel, do some funky stuff, then sew you closed with a needle and thread. In essence, every decision comes down to whether that assault is truly necessary or not. Thus the ability to deal with stress and think clearly at all times of the day is required. Interestingly, we used to say that surgery is about attention to detail, a watchphrase have seen used often in elite military circles as well. (not equating the two) Traditional teaching states that 90% of post-operative complications can be directly traced to technical failure in the OR. I have to know internal medicine/ pediatrics/ OB-GYN/ radiology etc. to diagnose the patient and assess the need for surgery, know all that information in order to support the patient during and after the surgery, know the technical aspects of performing the procedure, and be able to do it as well at 9AM after a good night sleep or at 3AM on no sleep at all; surgery has a way of frustrating schedulers and lasting longer than anyone expected. So making surgeons train the way we have to practice is a very good idea.
When a patient walks into the emergency room, and says to me "my stomach hurts," it is often 16 hours later that I have a confirmed diagnosis and see the patient concious again. If I go home I do not learn as much as I should, and in a sense the trade-off becomes whether we should have well-rested residents or well-trained independent practitioners.
There is no doubt though, that abuse takes place. I once went 10 weeks continuously on call every other night. Several of those weeks bordered on 140 hours in the hospital. At the end of that period I literally had no idea of day or night. Fortunately, the safety issue is addressed by many laws against overworking residents, by providing us places to sleep while on call when we can, by senior attendings who are available to us for help at anytime, and by us looking out for each other. We are quite stringently supervised because the senior surgeons feel a great deal of responsibility for their patients also. Our failure can have grave repercussions for them personally. No one will allow a resident to do something unles s/he demonstrates competence beforehand. Finally, there are nurses, assistants, PA, and ancillary staff, who will all try to have the patients best interest in mind, providing a network of checks and balances of sorts. Patients in hospitals with residents have consistently better treatment outcomes. Although there are instances of failure on the part of hospital leadership and administration which overburdens residents, by and large residents are very well supervised and supported. Of course, one has to recognize when one needs help and ask for it. No one likes a cowboy.
However, because residency training is paid for by the federal government out of Medicaid, the resident tends to work a lot of hours. The government pays the hospital x-amount per resident (I believe it was around 75K a few years ago). The hospital pays me a fraction of it, and because of me they don't hire a PA for 80-90K a year. Thus every patient I saw on my measly salary made/saved the hospital money. Just the way it works.
Many residencies are moving away from the current model. In surgery, so many people were quitting or not considering the profession at all that something had to be done to improve work hours. And we were losing quality female applicants. Whether quality of care will stay high remains to be seen. I think it will remain the best in the world.
