How many hours should a PA resident work?

[medic25]

I was having a bit of a philosophical debate today about PA residencies, and one thing that came up was how many hours a PA resident should be expected to work. Should a PA resident be expected to work the same grueling hours as their MD counterparts, or should a resident work a traditional 40-hour work week? I would argue that with only 12-18 months, the resident should be held to the same standard as the physicians and get in as much learning as possible. My colleague felt that for PA's who could come out of school and go straight to work, it would be excessive to expect them to upwards of 80 hours a week for less than what they'd make with a regular job. Thoughts?

[rev ronin]

No to the longer hours. I work about 50-55 hours per week, for a "1.0 FTE" job, and that's plenty. If a residency would get me a board certification to do anything independently, I'd have to look at that on a case-by-case basis, but I see no reason to sign up for the psychic meat grinder if I don't come out a board-certified physician on the other end, no matter how long or short it might be.

[LT_Oneal_PAC]

when I do a residency, I expect an 80 hour work week. I would feel cheated if I was not held to the same standard and treated equally in most, if not all, aspects of residency training compared to MD colleagues. The time spent at the hospital is was allows you to see so much, perform so many procedures, and get the really cool cases. Otherwise I would just get a regular job if I didn't want the best training, regardless of pay.

 

 

Sent from my iPhone using Tapatalk 2

[EMEDPA]

60-80 HRS.

Same as md resident in same specialty.

[myironlung]

the pa resident should be able to work at least 40hrs/ week. Anything more than that should be up to them. we're all in control of how much we learn (for the most part). some will work more to learn more. beyond that i can't see the benefit of working more hours.

[LT_Oneal_PAC]

I don't understand how it's even a discussion. If you don't want to work the same hours as other residents, don't do a residency. Nothing wrong with that. It's a personal choice. Those who want to do the training 60-80 hours per week deserve not to be equated with someone who just did 40 every week. This sounds the same to me as saying "I want to go to PA school, but I shouldn't have to stay at school after five. And make the same grade as the guy who studied until 8." If we start making the schedule optional then it will diminish what it's worth, even for the ones who do choose to work the same hours. It wouldn't be any different than OTJ training.

 

 

Sent from my iPhone using Tapatalk 2

[True Anomaly]

PA residents should be held to the same standards hours-wise as physician residents. Period.

[EMEDPA]

yup. and pa students on rotation should be held to the same standards as 3rd and 4th yr medstudents.

100+hrs/week for trauma surgery? bring it.

[bgdog]

when I do a residency, I expect an 80 hour work week. I would feel cheated if I was not held to the same standard and treated equally in most, if not all, aspects of residency training compared to MD colleagues. The time spent at the hospital is was allows you to see so much, perform so many procedures, and get the really cool cases. Otherwise I would just get a regular job if I didn't want the best training, regardless of pay.

 

 

Sent from my iPhone using Tapatalk 2

 

Absolutely, why even be there if you don't want to do the time.

[bgdog]

the pa resident should be able to work at least 40hrs/ week. Anything more than that should be up to them. we're all in control of how much we learn (for the most part). some will work more to learn more. beyond that i can't see the benefit of working more hours.

 

You can't see the benefit of seeing more pt's, of seeing more pathology, of doing more procedures, of constant learning and growing?

 

When I'm am coding, please don't be the one at my bedside.

I want the person that has done a million of em, that can do em with their eyes closed, that doesn't have to think about it because he/she has the muscle memory that only comes from doing so fricken many of em, all day, all night, all week, all year.

 

I want the person saving my life to have passion for what they do and the self discipline to do whatever it takes to learn no matter the time.

 

I want the person saving my life to not punch the clock at 5pm because they've done their 8 hours.

 

You only get good at something if you do it all day, every day for years.

 

All day every day for 1 year will get you closer than you are today.

 

This is a big kid sandbox.

 

Step aside if you can't hang.

[rev ronin]

That's funny, I want the person attending to my loved ones to have gotten a good night's sleep for each of the last several nights. I don't want someone who works unreasonable hours taking care of them any more than I want them to see a surgeon who throws instruments or sexually harasses nurses.

 

12 and 24 hour shifts are doable; people do them all the time. But not back to back to back to back... except in medicine. Sure, we all work overtime, when the situation demands it. But setting up students so that they are expected to function sleep-deprived on an ongoing basis is stupid and inexcusable.

 

Passion is not an excuse for recklessness. Tolerance for overindulgence is no more admirable when it's time spent in the hospital than when it's alcohol consumed. And no, there is no proven benefit to seeing more patients when the learner is exhausted.

 

Some of us "get" that. Some, obviously, do not.

[LT_Oneal_PAC]

That's funny, I want the person attending to my loved ones to have gotten a good night's sleep for each of the last several nights. I don't want someone who works unreasonable hours taking care of them any more than I want them to see a surgeon who throws instruments or sexually harasses nurses.

 

12 and 24 hour shifts are doable; people do them all the time. But not back to back to back to back... except in medicine. Sure, we all work overtime, when the situation demands it. But setting up students so that they are expected to function sleep-deprived on an ongoing basis is stupid and inexcusable.

 

Passion is not an excuse for recklessness. Tolerance for overindulgence is no more admirable when it's time spent in the hospital than when it's alcohol consumed. And no, there is no proven benefit to seeing more patients when the learner is exhausted.

 

Some of us "get" that. Some, obviously, do not.

 

I agree that someone well rested is optimal, but errors increased 20% after residency work hour restrictions were implemented.

 

http://m.usatoday.com/article/news/2018873

 

 

Sent from my iPhone using Tapatalk 2

[rev ronin]

I agree that someone well rested is optimal, but errors increased 20% after residency work hour restrictions were implemented.

 

http://m.usatoday.com/article/news/2018873

 

I'll buy such a counter-intuitive result when there's a blinded RCT supporting it. Can't be double-blinded, obviously, but I'm sure all of us (excepting maybe some of the students and Pre-PAs who haven't had evidence-based medicine yet) can see the problems in those who benefit most from higher resident workloads participating in such a study.

[LT_Oneal_PAC]

I'll buy such a counter-intuitive result when there's a blinded RCT supporting it. Can't be double-blinded, obviously, but I'm sure all of us (excepting maybe some of the students and Pre-PAs who haven't had evidence-based medicine yet) can see the problems in those who benefit most from higher resident workloads participating in such a study.

 

Good thing I've had numerous research and EBM courses then. It's not the highest level of evidence, but it is evidence. Unless they were blatantly lying about numbers, it's hard to have bias influence self reported mistakes in terms of absolute numbers with no statistical manipulation involved. Not a math whiz or anything. Besides, it's not so far fetched when considering additional hand offs decrease continuity of care, which we all here know, increases errors. Not to mention the decrease in education time and less procedural practice.

 

I'm not trying to argue that a sleep deprived is better. Just presenting evidence.

 

 

Sent from my iPhone using Tapatalk 2

[bgdog]

That's funny, I want the person attending to my loved ones to have gotten a good night's sleep for each of the last several nights. I don't want someone who works unreasonable hours taking care of them any more than I want them to see a surgeon who throws instruments or sexually harasses nurses.

 

I guess that's the difference between me and you then.

 

You want someone who is well rested.

 

I want someone who knows what they are doing.

[PAstudent59]

You can't see the benefit of seeing more pt's, of seeing more pathology, of doing more procedures, of constant learning and growing?

 

You only get good at something if you do it all day, every day for years.

 

All day every day for 1 year will get you closer than you are today.

 

This is a big kid sandbox.

 

Step aside if you can't hang.

 

absolutely agree. There is no such thing as too much experience and everything you observe or do will only serve to benefit your future patients. Why would a pa resident expect anything less?

[myironlung]

You can't see the benefit of seeing more pt's, of seeing more pathology, of doing more procedures, of constant learning and growing?

 

When I'm am coding, please don't be the one at my bedside.

I want the person that has done a million of em, that can do em with their eyes closed, that doesn't have to think about it because he/she has the muscle memory that only comes from doing so fricken many of em, all day, all night, all week, all year.

 

I want the person saving my life to have passion for what they do and the self discipline to do whatever it takes to learn no matter the time.

 

I want the person saving my life to not punch the clock at 5pm because they've done their 8 hours.

 

You only get good at something if you do it all day, every day for years.

 

All day every day for 1 year will get you closer than you are today.

 

This is a big kid sandbox.

 

Step aside if you can't hang.

 

If you read what I wrote (although your sleep deprived brain probably missed it, aside from likely medical ones as well) I said that I already knew working more hours lets you learn more if you so choose....then go on to say ASIDE from that I can't see your advantage.

 

And as far as i'm concerned if the PA is held to the same physician residency standards then I want the rewards to be the same. At the end of the day, everyone still has make a living.

 

Sounds like you're in the group around here who are medical harda$$es. So knock it off with the tough guy talk. Like rev ronin said, passion is not an excuse for recklessness. Give me the well rested and focused practitioner. Not the reckless harda$$.

[cstarkwe]

I am currently in an EM fellowship program. Our program is 1 year long. I worked about 57 hours this week including lectures. I can tell you from experience that I would not be able to do much more than that. It's an extremely high stress environment. I like to have time at home to decompress and do some independent studying. I do not feel that we should be held to the same standards as MDs/DOs because we are NOT MDs/DOs. If I wanted to do a physician residency, I would have been a physician. Who can fault me for that?

 

Just my two cents.

[EMEDPA]

I worked 65 hrs this week at 3 facilities in 2 different states and did several hundred miles of driving between sites. it's doable, it's just not easy.

if I did an em residency I would expect to be treated exactly like an em md intern. if we want to do something close to their job we need training as close to theirs as possible.

on my trauma surg. rotation I did > 100 hrs/week for 5 weeks with 1 day off for the whole rotation.

[tunafish]

You can't see the benefit of seeing more pt's, of seeing more pathology, of doing more procedures, of constant learning and growing?

 

When I'm am coding, please don't be the one at my bedside.

I want the person that has done a million of em, that can do em with their eyes closed, that doesn't have to think about it because he/she has the muscle memory that only comes from doing so fricken many of em, all day, all night, all week, all year.

 

I want the person saving my life to have passion for what they do and the self discipline to do whatever it takes to learn no matter the time.

 

I want the person saving my life to not punch the clock at 5pm because they've done their 8 hours.

 

You only get good at something if you do it all day, every day for years.

 

All day every day for 1 year will get you closer than you are today.

 

This is a big kid sandbox.

 

Step aside if you can't hang.

Are you 21yo??? What one has to do with the other? There are good mentors and bed mentors. There are people who teach you and people who use you and hours don't matter. What hospital you are in and who is in charge of your training means way more than the hours you spend there.

[rev ronin]

You want someone who is well rested.

 

I want someone who knows what they are doing.

 

Except that people who know what they're doing and have a choice... get a good night's sleep.

 

I absolutely want people who are lifelong learners. Residency isn't a magical time of life where being sleep deprived has no consequences and after which no additional learning can take place: It's a structured way to get all the basics down. And since specialist PAs work with board certified physicians, even specialist PAs STILL don't need to have the level of exposure or experience that a specialist physician does.

 

If you look at some of the "what do I do before PA school?" threads, you'll see I strongly recommend against vacations or slacking off, for much the same reason that I recommend against herculean hours in residencies: slow and steady wins the race. Train yourself to work a reasonable and sustainable workweek, and you can do that for 45+ years.

[rev ronin]

Good thing I've had numerous research and EBM courses then. It's not the highest level of evidence, but it is evidence. Unless they were blatantly lying about numbers, it's hard to have bias influence self reported mistakes in terms of absolute numbers with no statistical manipulation involved. Not a math whiz or anything. Besides, it's not so far fetched when considering additional hand offs decrease continuity of care, which we all here know, increases errors. Not to mention the decrease in education time and less procedural practice.

 

The comparison, presumably, is from self-reported errors before work hour limitations, where no one had any incentive to present high numbers, to self-reported hours after work hour limitations, where entrenched attendings and residents with Stockholm syndrome can document more errors in order to make a change they dislike look bad. It's well-documented that simply by changing reporting incentives (or removing DIS-incentives), you can capture more near-misses that were likely there all along but never reported. Remember, less resident labor means more PAs or attendings who have to pick up the slack, and that impacts their profitability and quality of life.

 

I don't doubt there's entirely probably some new errors with handoffs, but that confounder doesn't address sleep-deprivation errors, it just introduces another place where medical safety needs to be improved.

 

I WOULD like to see how much "education time" is lost by work hour limitations, specifically primary education time--lectures, grand rounds, pimping--vs. time where residents are just not working as many hours or seeing as many cases.

[mjohn7wy]

I seem to be with the group here who have completed residencies, if you sign up for the extra training expect the extra training, 60-80 hours following the same rules acgme applies to residents. The point is to learn by exposure and experience. It's also why the residency tract isn't for everyone, if you went into the field because you didn't want the md/do schedule then the residency tract likely isn't for you. It's hard and I don't sleep enough more often then I do, but the experiences I have had over the year are well worth it. It's definitely not for everyone but its also not required

[LT_Oneal_PAC]

I seem to be with the group here who have completed residencies, if you sign up for the extra training expect the extra training, 60-80 hours following the same rules acgme applies to residents. The point is to learn by exposure and experience. It's also why the residency tract isn't for everyone, if you went into the field because you didn't want the md/do schedule then the residency tract likely isn't for you. It's hard and I don't sleep enough more often then I do, but the experiences I have had over the year are well worth it. It's definitely not for everyone but its also not required

 

Exactly. Thank you

 

 

Sent from my iPhone using Tapatalk 2

[EMEDPA]

since specialist PAs work with board certified physicians, even specialist PAs STILL don't need to have the level of exposure or experience that a specialist physician does.

 

.

 

what about the pa who works solo coverage at a rural facility with distant backup by phone? there are places where PAs give tpa for stroke, TNK for stemi, and manage every single pt who presents without a doc on site.

in real time they are it. it's not ok to say " I don't need to know how to manage a difficult airway(or deliver a shoulder dystocia or do a paracentesis, etc), the doc will do it" in this setting.