Here was my schedule during residency training: Monday: arrive 5 am and leave the hopital when everything that needed to be done was done, usually about 7pm. Since call was every other night, I worked on call until the following morning, sleeping in the hosital on call room (my room mate was a ophthalmology resident who had to get up at 3am to prepare pre-op patients.)

Tuesday: Wash, rinse, repeat. Leave hospital about 7pm to do my laundry. Wash, rinse, repeat.

Wed: Same. On call

Thursday: Same. Off call

Friday: Same On call

Saturday: Conference morning from 7am-noon. Off call

Sunday: Same. On call

You do the math. I was usually too tired to. Then came work hours reform. Now residents can cruise through an 80 hour work week, and, at an average salary of $60K, doing it for minimum wage. Did I mention the median $200k in medical student debt?

A recent analysis of work hour reform and quality of outcomes, at a minimum, showed that the data suggests that the incremental experience gained from working more than 80 hours per week as a resident doctor doesn’t generally translate into improved patient outcomes later. And with rates of physician burnout increasingin recent years, it’s worth considering whether residency work hours could be reduced further, or restructured to address other causes of fatigue (such as electronic health records and insurance issues), without compromising clinical expertise and quality of care for patients downstream. Although there are no serious proposals to rethink residency training hours, it’s an open empirical question worth investigating.

I think we should pay attention to the quality not quantity of the work that gets done when we consider how to train the doctors of the future.

1. The doctor persona has changed.
   
   
2. The world has changed and we need to train people how to win the 4th industrial revolution.
   
   
3. The pace of innovation has changed and what you learn in residency will increasing be obsolete in shorter and shorter times after completion of your residency. Life long learning cannot be measured in hours per week and is just part of the job.
   
   
4. Physician productivity has been stagnant if not dropping.
   
   
5. Administrivia and EMR compliance mandates are wasting precious learning and practice time and frying doctors.
   
   
6. Medical schools and residency programs are facing these problems as well.
   
   
7. Here are my principles of medical education reform.
   
   
8. Technology is forcing us to confront the high tech-high touch tensions in care.
   
   
9. Data might be the new oil but sick care is the new coal.
   
   
10. Hospital based care compared to training in non-hospital care delivery environments is bcoming a smaller and smaller part of how the work gets done.
    
    
11. The business of medicine should be another ACGME competency.
    
    
12. Frustration and burnout are resulting in practitioners pursuing non-clinical careers or abbreviated clinical half-lives.

The quality of a graduating resident has more to do with the quality of their training, not its quantity. Yes, case numbers are important, whether it be an internal medicine resident or a ear, nose and throat resident. However, case exposure is frequently random and competencies are variable no matter how many you see or do or how many hours you work. Scut work adds little to learning. Continuous learning is a challenge.

You never get it completely right no matter how many hours you clock doing it. The 10,000 hour rule is a myth. I don't think an extra 6,000 hours will make much difference either (80 hours x 50 weeks x 4 years). That's why it's called practicing the art of medicine.

How does the 10/20/30 plan sound to you now?

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Twitter@ArlenMD and Co-editor of Digital Health Entrepreneurship.