It can cost upwards of $180k per year to train a resident in the US. Stop with the BS about how much revenue they bring in... they don't, and they're a liability.

When I worked at an academic center my residents were often out the door on non-call days hours before I finished. And you spend a ton of time teaching, looking for and catching errors, and explaining to angry family members why what the PGY1 said on pre-rounds was incorrect. Residents don't bring more quality of life to attending, but quite the opposite. Academic attendings are rewarded by being paid less than their private practice colleagues.

I tend to agree with most of what Vanilla says. I’m a relatively new private practice general surgeon and I’ll tell ya, I wish I had more time in residency, or at least more time for what I do.

I trained in the days of the “80 hr work week”. All the older folks say they are much better than us because they worked 120 hrs, etc. I think they may have graduated slightly better at overall surgery because they didn’t have to deal with as much administration as we do and most things were operative back then, AKA trauma solid organ injuries, AAAs, or intraabdominal abscesses are a few quick things that come to mind vs now we nonop most of those things.

Additionally I think they had the confidence to think they were good to go after residency because they had more autonomy back then. Most hospitals require attendings in the room now vs back in the older days, residents could operate alone. The ACGME leaves it up to the attendings to allow residents to operate alone but the hospitals have rules that supercede that if more conservative.

This all being said my 80hr work week was never such. Always in the high 90s and on transplant in the low 100s. But we log it as 80. Because we don’t want to get in trouble or losing credentialing.

I would be in favor of lengthening residency with the last year kind of a…. Pseudo attending year where you can operate alone with someone in the hospital in case you need it. You run your own clinic, take your own call, etc. and then having less hrs per week.

But I don’t think I would be in favor of tacking on more years for that. I’d like to get rid of some of the basic science in medical school. I spent a year relearning basically everything I learned in undergraduate courses. That I never use now. I’d just put those things as prerequisites to medical school.

I’d also like to see more direct pathways to specialities ~5 years if one chooses. I do private practice MIS/gen surg. I spent many many many hours and days helping with liver and pancreas transplants that I do not feel help me on a regular basis, or ever. Maybe see a few but not spent 20 weeks on the service. That time could have been seeing and doing more bread and butter surgical cases. Same with endovascular and etc. vascular and CTS are moving toward this.

For those that aren’t sure what they want to do they would have to finish formal residency and then do fellowship like we currently have.

For things like family medicine, emergency medicine, peds, and derm, it already seems very doable how it’s set up. They didn’t seem to work many hrs at all given how their speciality. Good for them!