Bad Idea to schedule my neurosurgery at a teaching hospital in July?

May 16, 2015 12:02 AM

I've often heard that, if you're planning to have a non-emergency surgery done at a teaching hospital, it's best to avoid scheduling it for July; that's when all the brand-new medical graduates begin their first internships, so the level of confusion and mistakes might reasonably be expected to be a little higher than at other times. Is this still significantly true, or is it a non-issue anymore? Is there any reason it would matter more or less with neurosurgery than with with other departments?

I expect I'll be needing some sort of surgical decompression for cervical stenosis pretty soon. I see the neurosurgeon for a consultation in mid-June. The scans and neuro exam have been done, so I don't think we'll need to take any more time for diagnostics. If the surgery were scheduled for a couple weeks after that visit, that would be early July. July would be very convenient for me, since it's a time when my driver/caregiver could be around to help with whatever needs doing (I live alone, and don't drive. ) If the specifics matter, this is at Albany Medical Center in NY.

Any strong opinions to hold out for August or September? Of course if the doc says it should be done ASAP, that's the opinion I'll listen to. I'm expecting he'll say, "whenever, within reason."

So, would scheduling in July add a meaningful downside risk? Would late July be better than early July?

posted by Corvid to Health & Fitness (5 answers total)

The timing of your surgery in this case isn't at all an issue, since the new graduates you're thinking of — residents, or more accurately, interns, as they're in their first year of postgraduate training — probably won't even be coming anywhere near you in the OR unless it's to close up your incision, or retract, or irrigate, and even then...

In my experience, depending on the complexity of the procedure at hand, the attending neurosurgeon usually does the critical parts of the surgery after taking over from the chief resident or a senior resident. Then they hand it back over to the resident. Sometimes the attending comes back on, sometimes not. These residents will have had 4 to 7 years of postgraduate training in neurosurgery behind them, so they're not exactly brand-new. Some training programs, however, do emphasize giving their residents more autonomy in the OR earlier on in their training, though. If it makes you feel better, you could ask your surgeon how he handles cases like yours, in how and when he expects his residents to step in.

In sum, the July effect does exist, but for the reasons mentioned above, there isn't one for neurosurgery, specifically spine surgery. So feel free to schedule it for whenever's most convenient for you.
posted by un petit cadeau at 12:18 AM on May 16, 2015 [9 favorites]

Yes to everything un petit cadeau said (that's so fascinating that there's a specific study on this!). No, I would not expect there to be any major difference with holding out for August or September. What a lot of people don't realize is that many places have monthlong rotations. So for example, in my specialty, interns can start out on OB/GYN, then go to anesthesia the next month, then emergency medicine the next month. So let's say you go in on September 1st with a headache to the emergency department, you're still getting an intern on their first day there, now with two months' experience as a physician but not in areas relevant to your care. I don't know enough about neurosurgery curriculum to know what sorts of rotations they do, but it probably doesn't matter for the reasons mentioned above. You might want to have an advocate to look out for you on the wards and try to double check any meds or tests you're getting or let people know about meds or tests you're not getting that perhaps you ought to, but that's a good idea no matter when you have your surgery done.
posted by treehorn+bunny at 12:50 AM on May 16, 2015 [1 favorite]

nthing the above. I had colorectal surgery in July a few years ago and specifically asked my surgeon about the July effect. My surgery was a relatively complex case -- not an appendectomy, cholecystectomy, etc -- and he explained that he would only be letting fellows anywhere near me, let alone new residents or interns. In your shoes, I wouldn't worry about this particular aspect.
posted by telegraph at 4:56 AM on May 16, 2015

While you're unlikely to have a problem with the surgery itself, I'd still pack some extra patience. Many other departments such as nursing, dietary, labs, etc., likely will have new grads. Heck, the cleaning crew may finally have been able to fill that 4 month open position with a new grad! While they all will be carefully watched (which is good!), it may mean one extra person present to supervise and the new person may be slower or less familiar with protocols/the extent protocols can be changed.
posted by beaning at 9:31 AM on May 16, 2015

In addition to neurosurgeons, there are anesthesiologists. I had kidney surgery at UCLA in June several years ago - I don't know if the July Effect happens earlier sometimes or some places, but I had an interesting time being the subject of teaching with an alternative epidural pain relief strategy. No intern ever touched me, but the anesthesiologist in charge demonstrated and described everything he was doing, and it actually reassured me quite a bit knowing all the details.
posted by WasabiFlux at 11:44 PM on May 18, 2015