Dr. Richard Bosshardt
speaker
190 appearances
1 recordings
1 series
first heard Feb 2025
last heard Feb 2025
Dr. Richard Bosshardt’s voice in public audio — every appearance, attributed to the second.
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They came out and they took a law that was basically confined to New York from 1964 and made it nationwide. And that law was a reduction of residency hours. In other words, you can't take a trainee in any medical specialty and make them work more than 80 hours a week or more than 24 hours at a stretch.
And so that reduced residency hours dramatically because when I trained, it was not uncommon to work a 90 to 110 hour week. That was pretty typical. And be on call, you know, 36 hours straight. I once worked 48 hours straight. Not that that's a great thing, but, you know, you do what you have to do and you learn. You learn to operate under circumstances when you're tired and things like that.
And the idea was to reduce medical errors and things like that, which has been disproven. Studies have shown that that reduction in hours did nothing to improve medical errors. But that was one thing that cut back the hours for training and surgery. What was the motive there? The idea behind it, the reason that it occurred was because of a death.
A young woman died in New York because of a medical drug error, a very rare drug reaction. And her father happened to be a very prominent attorney. And he decided that the reason was that these residents were working too hard, they were too tired, and we needed to change that.
Yeah. I remember this. Yeah. And that was only confined to New York until 2003. Then it became a nationwide thing. General surgery is a five-year residency program, okay? In the first two years, you learn patient care. You learn how to take care of patients before and after you assist in operations. You do diagnostic, differential diagnosis, and you learn how to work up a problem.
And if you're good, if you're a good intern, if you're a good first year, second year resident, you know, they throw your bone on again. They'll let you do a hernia and they'll let you do an appendectomy and they hold your hand while you do it.
And then in the third and fourth years, you start to operate more, but you're always operating under the direct supervision of a senior resident or an attending, attending a fully trained surgeon. And again, you're having your hands held. I mean, they have to let you work. They got to put the knife in your hand. But they have to be good enough to do that and keep you out of trouble.
And if you get in trouble, to get you out of trouble. And so you spend those three to four years kind of honing your skills. And then in the fifth year, when you are what we call a chief resident, you're basically regarded as being a surgeon. And you do your cases, you assist the younger surgeons in their cases.
And the only time you call an attending surgeon in is if you're doing something very major, very complex, or if you haven't done this before. And so at the end of that fifth year, you should be able to walk out of the hospital and go anywhere and operate as a general surgeon and function fully independently. A study done in 2014 in the Annals of Surgery reported that 80% of patients
80%. Fellowships and whatever. Thoracic surgery, vascular surgery, colorectal, you name it. And that was in 2014, right? They surveyed program directors. These are the chiefs, the heads of surgical programs to find out what these residents that they were getting, what these surgeons that they were getting in Phillips were like.
They found that that 66% of them could not be relied upon to operate independently for more than about 30 minutes. that something like 30% or so could not handle tissues in a manner that was appropriate, atraumatically, if you will. 20-30% couldn't sew properly. Close to the same number couldn't identify the early signs of a complication. Some could not identify an anatomical tissue plane.
These are people that are graduates of general surgery residencies coming out of these programs and going to fellowships. The saddest thing is that when they survey the young surgeons themselves and say, well, why are you going into this fellowship instead of going out and practicing? More than half say it's because they did not feel comfortable.
operating independently after five years of training. So there's something very wrong with the training they're getting. They're not getting enough cases to do. They're not being allowed to operate. In some places, the attending surgeons are very hesitant to hand over a case to a younger surgeon. because number one, they're responsible for that case.
Number two, you're never going to be as efficient or fast as a young surgeon as you will later on when you've had more experience. So it takes longer and it impacts your day, your schedule. It's sad because they recognize this. I mean, these young surgeons recognize this.
It's a system failure. And the ACS recognizes this. And you know how I know that? It's because since 2014, they've initiated what they call a mentorship program. And what they do is they try to find experienced surgeons that will mentor these young surgeons to help them come up to speed.
Okay, so a young surgeon out of training that should be able to work on their own and finds that they're struggling or not really able to do that, They would have an experienced surgeon to, I don't want to say hold their hand, but to oversee them, supervise them, scrub with them. They can't find enough surgeons to do that, for one thing.
I'll agree with you on that.
So what happens when... everything starts to go downhill really quickly. People contact me just because my profile has been elevated by being out there a little bit. I got a call from a young plastic surgery resident that had been fully trained in general surgery and went on to begin her plastic surgery training. And she was concerned because she wanted to get the most out of her training.
And so she reached out to me to find out what things she could do. She told me things that were unbelievable. I mean, I never imagined these. And this has been confirmed. It wasn't just my conversation with her. I've confirmed it from other sources as well. A couple of things. One is she talked about the difficulty getting enough cases under your belt.
That is, you know, not getting given cases to do, not having operations that you can actually perform, not having the attendings turn things over to you. This I could not believe.
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