[senortumnus]

Surgeon here who does the majority of my “major case” work robotically. Author of this article has a coastal-centric point of view. My residency was apprenticeship model and I graduated very confident in my capabilities to perform robotic surgery “skin-to-skin”. The phenomenon he references about trainees no longer being able to start a surgery without the “attending” surgeon present is not related to robotics. It is due to CMS or liability (lawyers) or hospital policy regulations (lawyers). Same reason medical students are pushed away from direct patient care until they graduate and become residents.

See the article on HN yesterday for which the comment section was chock full of “tear down the health bureaucracy” rhetoric. If the general public comes out saying “we want trainees working on us, if it creates better doctors and lowers health care costs” then the system can become much simpler and get back to the old days of higher autonomy for trainees in academic centers.

Until then, advice for future surgeons: if you want to learn how to operate during residency, consider a program in the midwest without a lot of fellows.

[stephencanon]

I don’t think it’s so much “coastal” as “big-name (and big) programs”. Wife is an attending at a one-a-year program here in the northeast, and the residents definitely get _way_ more operating experience then they do at, say, Michigan.

The skills issue you identify with some big-name programs is a real thing for sure, though.

[Dracophoenix]

How long were her shifts as a resident? I remember reading an article about laws seeking to limit resident hours about a decade ago but I'm not of the opinion that anything regarding hours has really changed since the days of William Halsted.

[stephencanon]

They’ve been pretty successful about capping individual shift length (to a day and change, granted), the real killer is the total hours per week, which can’t really go down without either the government funding more residency slots or hospitals hiring a bunch of PAs to take over some of the workload, but why would they in a privatized system when the residents are paid for and can’t really leave?

[Dracophoenix]

How many hours a week? How much of it is actual medical work vs being on standby?

[ashtonbaker]

They’re capped at 80 hours per week, more or less. Most residents go over, regularly. But a single report of a work hours violations is a pretty serious deal for a residency program, so that alone means things are better than they used to be. On the other hand, programs tend to use everything from coercion to collective punishment to prevent these reports from being filed. In practice, this seems to work out as residents tolerating a certain amount of extra hours, as a matter of culture (this varies by institution and by specialty), but it doesn’t seem to be as bad as the old days. Just my limited perspective as a partner to a surgical resident.