New Supervision Rules for New Doctors - NYTimes.com
June 24, 2010, 3:15 pm
Ingolf Hatz/Corbis
1. June 24, 2010 3:40 pm
Link Leave it to oversight organizations to, well, over see stuff. And often WAY OVER SEE stuff. These are the same wonderful people that brought the idiotic No Child Left Behind boondoggle to education. Lots of quantifiable data that means diddly-squat to student OR teachers.
2. June 24, 2010 3:50 pm
Link Creating and enforcing training regulations is difficult business, espcially against a very ingrained culture of toughness and masochism.
3. June 24, 2010 4:21 pm
Link I am 35 years from my training… Things in residency may have changed, though I doubt the changes are much more than decoration… The one thing that does not seem to change is the continuous proliferation of people who have neither the training nor the license to practice medicine hell bent determined to tell those who actually do practice medicine that everything they do is wrong… And the comments by CA above are right on the mark… dr. o
4. June 24, 2010 5:01 pm
Link Pretty sure the ACGME had nothing to do with no child left behind.
5. June 24, 2010 5:23 pm
Link Dr. M sounds like an amazing mentor. Over the last decade, trainees have had fewers hours to work which was done with good intentions. The question is will the next generation of physician mentors be as good as the generation before?
6. June 24, 2010 5:35 pm
Link I went to see a gastroenterologist once, and saw the resident he was training first. That was fine. After they examined me, though, they proceeded to talk about my case, and the likelihood that I’ll develop a serious disease that isn’t related to gastroenterology, right in front of me. When I pointed out how unsettling this was, the doctor said that’s how training occurs. The discussion didn’t happen to happen right then and there, though–especially the speculative part.
7. June 24, 2010 5:51 pm
Link I would take this one step further. All doctors should be supervised throughout their careers by their peers. No one ought to be required or permitted to practice medicine alone.
8. June 24, 2010 5:57 pm
Link Does this mean that the intern must be fully supervised by an attending at all times? Where will all these attendings come from? As the insured population surpasses the current capacity of the health care system, adding yet another constraint to an attending’s time seems controlling and completely disconnected from the logistical realities of current medical care.
9. June 24, 2010 6:50 pm
Link Dr. Chen, stop fighting the work hour restrictions. As a transplant surgeon, you are again missing the forest for the trees. Working 36 hours straight doesn’t make you a better doctor. It makes you legally drunk if you were to take a field sobriety test, but it doesn’t make you a better doctor.
10. June 24, 2010 7:19 pm
Link Lila — There are already programs that can be granted duty hour exemptions up to 88 hours. That isn’t a change.
11. June 24, 2010 7:37 pm
Link Wow these new guidelines are extraordinarily weak and dangerous to patients…No one should be working 80-88 hours a week treating sick people, with or without “supervision”… Anyone who has worked in a hospital knows that the orders are put in by interns or residents despite the attendings’ supposedly constant supervision and frankly, as they are the most inexperienced staff, putting them under the most stress (80 hours!!!) will be something that I as a patient would strongly oppose…
12. June 24, 2010 8:18 pm
Link I don’t have a shred of nostalgia for the “way it used to be.” Residency training was brutal in the days before the admissions “cap” and the “hours restriction”. It is marginally better with the 80 hour work week. However, I must say that as an attending, I’ve had much less time to provide a solid educational experience, let alone be a “Dr. M” type of teacher because of the pressure to get residents out on time and then having to pick up more of the clinical pieces because they are not there. It’s not a complaint–I believe in the work hours reduction–just an observation. I do wonder how they do it in the EU where I believe they are mandating 48-55 hr weeks for trainees.
13. June 24, 2010 8:51 pm
Link In my experience your best bet is to be as nice as possible to the nursing staff. They know what’s happening and the good ones will bother the doctor until he/she will get off the phone and actually come and see you.
14. June 24, 2010 10:22 pm
Link We need many more doctors working fewer hours, excelling in professional skill, and fully awake. We are rated 39 in quality of health care in the world and have a severe shortage of doctors. Basta!
— gussieone
15. June 24, 2010 11:24 pm
Link I find these new changes infuriating! I’ve read and reread the recommendations and the goal is to increase supervision… by decreasing interns’ work hours? I don’t understand. I’m having trouble seeing how these two disparate aspects of medical education are related. Interns working night float will still have less supervision than interns working during the day–regardless of how many hours they spend in the hospital. Personally it seems just like another example of top-down, uninformed decision making by people in suits who have no idea what we actually do all day.
16. June 25, 2010 12:15 am
Link After actually reading the recommendations by Dr. Nasca, et.al., I’m wondering how “Supervising faculty should delegate portions of care to residents” and the “Progressive responsibility for care must be assigned by the program director and faculty” as mentioned in the recommendations would work. Because this flies in the face of the INCREASED supervision that the Federal government is mandating the faculty provide in order to get paid for medical care – a not insignificant problem in the current healthcare cost-containment environment we’re facing. Overall reimbursements are decreasing relative to inflation (see: Medicare Doc paycut), so therefore each source of potential revenue becomes highly important – as even salaried faculty need that revenue to cover their expenses.
— Julius Cheng, MD MPH
17. June 25, 2010 1:03 am
Link What’s with all the lay public pretending they know/understand medical training?
18. June 25, 2010 8:44 am
Link Do you really want to have your work-up done by a zombie intern? They’re under enough stress. Plenty of sleep, plenty of supervision, if not for their sake than for the sake of the patient.
19. June 25, 2010 9:04 am
Link Here is an idea: in the EU, people don’t spend four years getting a bachelor’s, half to two thirds of which is composed of crap courses, only then to begin their medical education. They go from high school into their medical program, the first year of which is basic sciences, then the med part. This accomplishes several things: they aren’t paying off six figures in debt for undergrad; they aren’t trying to do residency in the waning years of fertility when, if they want children, they have to get busy; they can take more time about their hands-on clinical training. it’s a great idea. C’mon, do we really need doctors who have had a semester or two or four of some watered-down feel-good course ending in “-studies”?
20. June 25, 2010 9:06 am
Link It seems like teaching hospitals are still using a business model from the 1950′s. Reforms are way overdue.
— Dan Walter
21. June 25, 2010 9:08 am
Link I am a psychiatry resident currently in fourth year of training, I would think psychiatry residency is traditionally lighter than lets say surgery, OBGYN, family med, internal med , but just due to the nature of our profession, supervision right from the firts year of training to the fourth year of training is mandatory. The supervsion is multiple levels: one has a second year resident who acts as a mentor while one is an intern in adition to having weekly supervsion with an attending and in the final two years, we have two attendings as supervisors. I think its really helpful and helps in the personal growth of us as physicians.
— Priyankar
22. June 25, 2010 9:29 am
Link Finally, all said above is a reminder of what has happened now that our health system is driven by reimbursement rates and medical insurance actuaries (or fickle Medicare rules) who decide what kind of medical service shall be rendered.
23. June 25, 2010 9:48 am
Link The system has to recognize the tireless nurses who work hard at keeping patients safe by monitoring (and mentoring) interns and either directly or indirectly – by calling a more senior doctor – bail out the butts of many young doctors who forgot that just yesterday they were med students.
— Leslie Durr, PhD, RN
24. June 25, 2010 10:23 am
Link The first comments the best, thanks, ca. I trained in the 1980′s and had a few doctors (mentors, really) like Dr. M and will remind the folks here that he did what he did because he cared about his patients and his young charges.
25. June 25, 2010 10:49 am
New Supervision Rules for New Doctors - NYTimes.com
June 24, 2010, 3:15 pm
Ingolf Hatz/Corbis
1. June 24, 2010 3:40 pm
Link Leave it to oversight organizations to, well, over see stuff. And often WAY OVER SEE stuff. These are the same wonderful people that brought the idiotic No Child Left Behind boondoggle to education. Lots of quantifiable data that means diddly-squat to student OR teachers.
2. June 24, 2010 3:50 pm
Link Creating and enforcing training regulations is difficult business, espcially against a very ingrained culture of toughness and masochism.
3. June 24, 2010 4:21 pm
Link I am 35 years from my training… Things in residency may have changed, though I doubt the changes are much more than decoration… The one thing that does not seem to change is the continuous proliferation of people who have neither the training nor the license to practice medicine hell bent determined to tell those who actually do practice medicine that everything they do is wrong… And the comments by CA above are right on the mark… dr. o
4. June 24, 2010 5:01 pm
Link Pretty sure the ACGME had nothing to do with no child left behind.
5. June 24, 2010 5:23 pm
Link Dr. M sounds like an amazing mentor. Over the last decade, trainees have had fewers hours to work which was done with good intentions. The question is will the next generation of physician mentors be as good as the generation before?
6. June 24, 2010 5:35 pm
Link I went to see a gastroenterologist once, and saw the resident he was training first. That was fine. After they examined me, though, they proceeded to talk about my case, and the likelihood that I’ll develop a serious disease that isn’t related to gastroenterology, right in front of me. When I pointed out how unsettling this was, the doctor said that’s how training occurs. The discussion didn’t happen to happen right then and there, though–especially the speculative part.
7. June 24, 2010 5:51 pm
Link I would take this one step further. All doctors should be supervised throughout their careers by their peers. No one ought to be required or permitted to practice medicine alone.
8. June 24, 2010 5:57 pm
Link Does this mean that the intern must be fully supervised by an attending at all times? Where will all these attendings come from? As the insured population surpasses the current capacity of the health care system, adding yet another constraint to an attending’s time seems controlling and completely disconnected from the logistical realities of current medical care.
9. June 24, 2010 6:50 pm
Link Dr. Chen, stop fighting the work hour restrictions. As a transplant surgeon, you are again missing the forest for the trees. Working 36 hours straight doesn’t make you a better doctor. It makes you legally drunk if you were to take a field sobriety test, but it doesn’t make you a better doctor.
10. June 24, 2010 7:19 pm
Link Lila — There are already programs that can be granted duty hour exemptions up to 88 hours. That isn’t a change.
11. June 24, 2010 7:37 pm
Link Wow these new guidelines are extraordinarily weak and dangerous to patients…No one should be working 80-88 hours a week treating sick people, with or without “supervision”… Anyone who has worked in a hospital knows that the orders are put in by interns or residents despite the attendings’ supposedly constant supervision and frankly, as they are the most inexperienced staff, putting them under the most stress (80 hours!!!) will be something that I as a patient would strongly oppose…
12. June 24, 2010 8:18 pm
Link I don’t have a shred of nostalgia for the “way it used to be.” Residency training was brutal in the days before the admissions “cap” and the “hours restriction”. It is marginally better with the 80 hour work week. However, I must say that as an attending, I’ve had much less time to provide a solid educational experience, let alone be a “Dr. M” type of teacher because of the pressure to get residents out on time and then having to pick up more of the clinical pieces because they are not there. It’s not a complaint–I believe in the work hours reduction–just an observation. I do wonder how they do it in the EU where I believe they are mandating 48-55 hr weeks for trainees.
13. June 24, 2010 8:51 pm
Link In my experience your best bet is to be as nice as possible to the nursing staff. They know what’s happening and the good ones will bother the doctor until he/she will get off the phone and actually come and see you.
14. June 24, 2010 10:22 pm

Link We need many more doctors working fewer hours, excelling in professional skill, and fully awake. We are rated 39 in quality of health care in the world and have a severe shortage of doctors. Basta!
— gussieone
15. June 24, 2010 11:24 pm
Link I find these new changes infuriating! I’ve read and reread the recommendations and the goal is to increase supervision… by decreasing interns’ work hours? I don’t understand. I’m having trouble seeing how these two disparate aspects of medical education are related. Interns working night float will still have less supervision than interns working during the day–regardless of how many hours they spend in the hospital. Personally it seems just like another example of top-down, uninformed decision making by people in suits who have no idea what we actually do all day.
16. June 25, 2010 12:15 am
Link After actually reading the recommendations by Dr. Nasca, et.al., I’m wondering how “Supervising faculty should delegate portions of care to residents” and the “Progressive responsibility for care must be assigned by the program director and faculty” as mentioned in the recommendations would work. Because this flies in the face of the INCREASED supervision that the Federal government is mandating the faculty provide in order to get paid for medical care – a not insignificant problem in the current healthcare cost-containment environment we’re facing. Overall reimbursements are decreasing relative to inflation (see: Medicare Doc paycut), so therefore each source of potential revenue becomes highly important – as even salaried faculty need that revenue to cover their expenses.
— Julius Cheng, MD MPH
17. June 25, 2010 1:03 am
Link What’s with all the lay public pretending they know/understand medical training?
18. June 25, 2010 8:44 am
Link Do you really want to have your work-up done by a zombie intern? They’re under enough stress. Plenty of sleep, plenty of supervision, if not for their sake than for the sake of the patient.
19. June 25, 2010 9:04 am
Link Here is an idea: in the EU, people don’t spend four years getting a bachelor’s, half to two thirds of which is composed of crap courses, only then to begin their medical education. They go from high school into their medical program, the first year of which is basic sciences, then the med part. This accomplishes several things: they aren’t paying off six figures in debt for undergrad; they aren’t trying to do residency in the waning years of fertility when, if they want children, they have to get busy; they can take more time about their hands-on clinical training. it’s a great idea. C’mon, do we really need doctors who have had a semester or two or four of some watered-down feel-good course ending in “-studies”?
20. June 25, 2010 9:06 am
Link It seems like teaching hospitals are still using a business model from the 1950′s. Reforms are way overdue.
— Dan Walter
21. June 25, 2010 9:08 am
Link I am a psychiatry resident currently in fourth year of training, I would think psychiatry residency is traditionally lighter than lets say surgery, OBGYN, family med, internal med , but just due to the nature of our profession, supervision right from the firts year of training to the fourth year of training is mandatory. The supervsion is multiple levels: one has a second year resident who acts as a mentor while one is an intern in adition to having weekly supervsion with an attending and in the final two years, we have two attendings as supervisors. I think its really helpful and helps in the personal growth of us as physicians.
— Priyankar
22. June 25, 2010 9:29 am
Link Finally, all said above is a reminder of what has happened now that our health system is driven by reimbursement rates and medical insurance actuaries (or fickle Medicare rules) who decide what kind of medical service shall be rendered.
23. June 25, 2010 9:48 am
Link The system has to recognize the tireless nurses who work hard at keeping patients safe by monitoring (and mentoring) interns and either directly or indirectly – by calling a more senior doctor – bail out the butts of many young doctors who forgot that just yesterday they were med students.
— Leslie Durr, PhD, RN
24. June 25, 2010 10:23 am
Link The first comments the best, thanks, ca. I trained in the 1980′s and had a few doctors (mentors, really) like Dr. M and will remind the folks here that he did what he did because he cared about his patients and his young charges.
25. June 25, 2010 10:49 am