5am this morning .... I am out running ... 8 mile run ... training ... marathon training ... it's been cold outside ... today, cold and a fresh coat of snow ... the numbers of runners are far fewer ... several people walking dogs ... very few footprints in the snow .... I run past a older man (grey mustache and hair) ... I've seen him before ... We are the dedicated few ... continuing our training regardless of the weather ... like the postal service .... rain or shine, we will be there .... we smile at each other with a kind of understanding not understood by those still in bed ....
I look at the young doctors coming into medicine now a days and their perception of what is expected of them and what they are willing to do is less. Will they run in a storm. Will they stay until all the work is done or will they say, " my shift is done" and leave.
Times are changing, but the patients are not. The amount of work that is needed to be done does not. Residency programs are now dealing with how do we adapt to the 80hr work week. It has become difficult for most programs to accommodate the restrictions. A number of things within residencies have changed to adapt to the changing hour restrictions. As programs become more accustom to working within the restrictions, so do the young physicians. They become more likely to schedule those hair appointments during the day (4:30pm or so) etc. The medical students leave without even checking out. I say strange. This is a definite change from when I was a medical student or resident. The expectation is different.
You may say, "Well, it is a different time and place. We don't need to do every other night call or stay in the hospital 2 days straight to be a good physician." And I would say, "You are exactly right." I do not think that you should spend countless hours in the hospital doing nothing. I would agree that more time spent reading and not doing busy work is probably better in the long haul. Andrew Palmer, MD, former president of the American society for Surgery of the Hand, made an opening address several years ago making a plea to many young physicians to find other interests outside of medicine. He felt that after many years dedicating his life to medicine, researching, operating, and teaching, he learned that there is a need to develop other interests. A need to develop yourself without medicine. So, I do feel that this is an important.
The problem we have now is the same problem that you get with unions. Yes, being formed is protective, but a certain mentality develops. The mentality developing now is that of a sense of entitlement. A sense that menial work is beneath them and that they should only do meaningful things. They don't need to prove themselves before we let them make decisions or make incisions.
Some may read this and say, "he is full of it. I am not like that." Well, not now, but there is a changing mentality. We had a visiting lecturer from the UK who gave us a lecture of the system in Britain. He was describing their work hour restrictions and how they have adapted. They are now down to, I think, 48 hrs a week. He says now they have more residents, to cover the time; the number of "hand off" errors have increased; and the operative case number is dropping. He reported to us when the restrictions began, the residents there said, "we will stay, regardless of the restrictions." Now, when time is up they just leave, regardless if they are in the middle of a case or in clinic, time is up and they are gone.
This mentality will creep slowly into the mentality of most as it has done in the auto industry. I fear the development of shift workers. I say that the medical students and residents are weak to incite anger in you. I want you to prove me wrong. Prove to me, yourself, that you have the fortitude to weather the storm, the cold, and the snow. Maybe one day when I am old and grey I will see you and we will smile together with an unspoken understanding.