Letter to The Editor
March, 2002 Edition
In A Single Voice
Bernard M. Jaffe, M.D.
Dear Dr. Jaffe:
I have been an admirer of you for years and read
this editorial with a special interest. Your points are well taken
and I understand your concern for the well being of the patient as well
as the accuracy that needs to be defined by the Physician of record. It
is clear that in today’s practice of medicine and surgery there remains
less time to communicate with the Physician, which has caused concern among
the recipients of our care, the patient. Other providers have been
required to take up the slack and this sometimes has created confusion
for the patients and their families.
Your editorial was extremely focused and the concerns
that you have demonstrate your strict observance of protocol combined with
your sensitive heart toward the welfare of the patient. I can readily
see this dichotomy. Corrections are placed on both Nursing and the Resident
staff. It is no secret that medicine as we know it will be obliged to undergo
a change after July1, 2003. The mandatory 80-hour workweek for Residents
will cause a ripple in the force yet there has been much critical thinking
ongoing in the past year. The ACS meeting in San Francisco last month
placed this situation in the spotlight and solutions have been suggested.
Among the solutions will be an increase in the use of non-physician providers,
in particular, Physician Assistants.
As a Surgical Physician assistant in practice
with the same Surgeon for 30 years and as a leader in the surgical PA profession
I would request that you either write an article on the implementation
of PA’s in surgical practice or that you provide us with some guidelines
so that we do not cross the line and we meet the expectations of the surgical
community.
We endeavor to continue to serve our Physician
Attending and our Patients and provide the highest standard of care.
We appreciate the necessity of the Physician led team and therefore implore
you to provide us with the necessary direction. I extend my gratitude
in advance.
Sincerely,
Robert M. Blumm, MA, RPA-C
Chairman, Surgical Congress AAPA
Hospitals Face Limit on Residents'
Hours
By THE ASSOCIATED PRESS
Filed at 7/01/2003 8:03 a.m. ET
BOSTON (AP) -- For the nation's bleary-eyed doctors-in-training,
life gets a little easier Tuesday, when new regulations go into effect
to limit their hours to 80 per week.
The new rules -- a response to growing evidence
that exhausted young doctors burn out and make too many mistakes -- will
help them get some much-needed shuteye. But the regulations could prove
burdensome to the nation's 1,100 teaching hospitals, many of which are
already on the financial precipice.
To absorb the costs of training young doctors,
teaching hospitals have come to depend on cheap labor from residents, or
doctors fresh out of medical school. Residents handle a variety of tasks,
from scut work to surgery.
But now, those 100,000 residents will be working
millions of hours less, while the workload for hospitals will stay the
same.
The new standards, issued by the Accreditation
Council for Graduate Medical Education, generally cap shifts at 24 straight
hours and require a 10-hour break between them. Previously, residents sometimes
worked 110 hours per week or more, particularly in fields like surgery.
Previous reform attempts have flopped, but this
time hospitals could lose their accreditation if they break the rules.
Hospitals have been preparing for the guidelines
for more than a year, so no sudden changes are expected Tuesday. The guidelines
have already changed how teaching hospitals operate. Hospital officials
insist the rules have not hurt patient care so far.
Some hospitals, like Baylor University Medical
Center in Dallas, have reduced the nights residents are on call (when they
work two straight days and the night in between) from every third night
to every fourth. Georgetown University, University of Iowa Health Care
and Boston's Beth Israel Deaconess Medical Center are among those to implement
or expand ``float'' systems, where a team of doctors arrives at night so
others can leave.
Beth Israel and Massachusetts General, also in
Boston, are hiring more nurses and physician assistants. Around
the country, older doctors are expected to be asked to take up some of
the slack.
Many hospitals say they support the changes, but
they are not without consequences. Physician assistants are expensive,
commanding salaries of $80,000 plus benefits in Boston.
Night floats, meanwhile, ensure patients see fresher
doctors, but those doctors may not be familiar with the patients' cases.
``Any way you do it, there is some disruption
in continuity of care,'' said Dr. Ronald Jones, who heads the surgical
residency program at Baylor.
Dr. Andrew Lehmann, chief resident in internal
medicine at Georgetown University Hospital in Washington, said his fellow
residents mostly welcome the changes. But telling doctors it's time to
``punch out'' teaches bad habits, Lehmann said.
``Once they go out into the real world, they're
not going to be able to just sign out at noon if their patients are doing
poorly,'' he said. ``That's part of the deal you accepted when you signed
up to be a doctor.''
But Dr. Alex Molnar, who just finished her first
year of residency -- usually the most grueling -- at Brigham & Women's
Hospital in Boston, enthusiastically supports the guidelines.
``We can go ahead and spend more time thinking
about the medicine, and less time monitoring ourselves for sleep and deciding
whether we need extra help,'' she said.
At some hospitals, the guidelines may have inspired
new efficiency measures.
Massachusetts General, for instance, hopes to
use wireless technology to monitor patients' vital information, freeing
up residents from doing ``pre-rounds'' -- spending an hour collecting data
before their real work began.
Dr. Debra Weinstein, who oversees 1,400 residents
at Massachusetts General and other area hospitals, is reserving judgment
until she sees the results of an extensive study the hospital is doing
on how the hours affect patient care and medical education. But she said
she is confident that, in a pinch, patients will still come first.
``Doctors 100 percent of the time will take care
of the patient before they follow a rule that says their shift is over,''
she said.
Hospitals insist the limit on residents' hours
do not mean lesser care, since doctors hand off patients to colleagues
all the time. Besides, the guidelines have some flexibility; for example,
in some instances, residents can stay at work to see a case through if
necessary.
``We're not talking about a factory floor here
where people put down their tools and go home,'' Dr. Jordan Cohen, president
of the American Association of Medical Colleges. ``There are patient needs
that need to be attended to, and that's going to trump anything.''
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