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Tue, 18 Jun 2002 12:41:02 EDT

       I never thought I would be writing a memo like this one.   Many of us 
have been expressing our opinions on this web site, but I have been seeking 
information and communicating elsewhere.   The expressions on this web site 
are not and will not be welcome to those agencies that are moving full steam 
ahead.  The news networks and newspapers have decided that what will be the 
end game.   I heard comments even this morning which made fun of the any 
surgical mentality comments.  

We are being compared to reactions to death and grief as written by Elizabeth 
Kubler Ross.  We are seen to be in a "bargaining" phase rather than an 
adjustment phase.   Surgical training programs for county hospitals may be a 
thing of the past as many deans, chairs of surgery, surgical chiefs at VA 
hospitals are saying, we need to get to a 40 hour work week for students, 
residents and staff.  Punch a clock.  We are in conflict with many of the 
various regulatory agencies.   The ACS COT VRC requirements are totally 
incompatible with the new ACGME, AMA, AAMC, regulations.  We are witnessing 
Catch 22 and we will NOT win this one.  

I recommend that we all TRY to use the manpower we have and try to work our 
the math for providing the care required while still accomplishing the punch 
card for the surgical RRC.    SOMETHING in our educational and service 
programs will have to go.   For many cities, it will be the trauma program at 
the county hospital which will go first as that requires in house 24/7 
coverage.   It will be impossible to cover both elective and emergency 
surgery.   Surgical critical care will also be one of the early causalities.  
  Surgeons will become tradesmen with the workup and follow up provided by 
others, often non MDs.   If we can work out the numbers and the required 
call, then bully for us and let us share the math.   If we cannot work out 
the math within the ACGME guidelines then we need to change some of the other 
regulations such as ACS COT VRC, might need to change.    We can then be part 
of those changes.    

I am convinced this AM that this is part of a national programed activity, 
and unless the ACS, ABS, or others step forward with a BIG stick, this month, 
surgery as we have known it will no longer exist.   The voices on this web 
site are the minority.    The lawyers, hospital administrators, ACGME, AMA, 
AAMC, congress, etc have decided that work hours and "unsafe" doctors will be 
a major agenda.   

Let us stop the bargaining and denial and figure out how to maintain the 
quality, the education, and the math.    

k

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