Question: I'm curious as to what the experience has been, not in terms of the workhour restrictions to which we as cardiology trainees are subject, but rather, do you think that the workhour restrictions on residents has had an effect on what you are expected to do as fellows? Is work flowing uphill? Is it flowing over fellows' heads to attendings? Is it being shifted over the physician extenders? And perhaps most important, do you think that we're at steady state, or are shifts going to continue?The conversation is shifting. Traditional hierarchical patient management is giving way to the need for "scut management" as work hours, thrown in amongst teaching sessions, draw short. Divide-and-conquer. No time for supervision. Hurry up! We've got to get done!
Work hours restrictions have definitely changed the nature of training. The hierarchical roles where attending supervises fellow supervises resident supervises intern is shifting to a divide-and-conquer strategy where housestaff divvy up the work to get everything done at the expense of knowing every patient. Interns were once expected to get all the scut done on all their patients while the senior housestaff managed; now interns/residents/fellows are dividing the scut which comes at the expense of interns learning management of clinical scenarios from their senior housestaff at an earlier point in their training. Meanwhile, attendings still have to manage every single patient, so their jobs have probably become more difficult since the new work hour rules have been put into place. Attendings have to spend more time directly managing more junior housestaff.
More surprisingly, trainees are now perceiving a tectonic shift in patient care responsibilities as attendings "manage every single patient" and rely less and less on their presence. Housestaff are becoming fearful that they will be marginalized members of the patient care team. Meanwhile, they witness the change in their attending's quality of life. Suddenly, the lure of the title "senior attending" is losing its luster.
And home life for the attending? Well... Oh, geez, I better call home!
"Sorry for calling so late dear. Yes, dear, I should be home soon."
"What's that dear? Why can't the residents finish up? Well, you know, they've left. They can only work so many hours..."
"Say what? Who made those rules? It really doesn't matter... (Holding phone away from ear)... I know you don't give a damn about those residents, dear. But someone has to manage the patients, dear."
"Birthday, whose birthday? You're kidding, right. (Looks at calendar and thinks, "Oh no! I'm so screwed!") I'm so sorry dear. Er, uh, I'll come back later to finish up, dear. No problem, I'll get changed and get home right away..."