Kevin has a good article in the USA Today about the negative consequences of resident work hour reform. In it, he notes that patient "hand off" errors and the lack of operative exposure a surgeon-in-training gets during residency can adversely effect both patient care and the ability of future doctors to handle complex situations.
I also just read a crappy paper in Archives about the effects of the 50 hour work week limitation currently in use in Switzerland. The overwhelming majority of attending and resident physicians stated that the reforms negatively affected operating room experience and overall patient care. Who would have thought that working as much as a middle manager at a Toyota plant would adversely effect a surgeon's training and performance.
If you live in the Atul Gawande world, none of this bothers you. In this world, sub-sub specialist physicians are only responsible for a tiny sliver of medical knowledge and so there's really no reason to be spending 100 hours a week in a hospital during your training. A fully integrated, multidisciplinary "system" will take care of everything. You won't need a general surgeon. The thyroid guy will take out your thyroid gland. The biliary guy will remove your gallbladder. And the colorectal guy can take care of your hemorrhoids. Don't you worry.
Don't you wish there was "a guy" for everything!?!!
As for the "lack of operative exposure" during residency, I am feeling this on my own skin. Nothing could be further from truth. I hope I won't make any bad calls after finishing my residency, though.
As long as these super specialty guys don't bar the general surgeons from performing the same procedures what's the problem?
I think Obama's plan is great because the system is gouing to tip over a couple of decades earlier and proper reform is going to be necessary.
Keep up the interesting blog posts Mr Buckeye
Where are all those 'guys' in the middle of the night?
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