EP Award Promo

Meet the Incredibles


Ask for 15 minutes of Dr. Jennifer Beatty’s time, and depending on the time of day, you might have to catch her between surgical procedures as she devours a microwaved lunch.

A fourth-year surgical resident in Iowa Health-Des Moines’ graduate medical education program, Beatty typically spends at least eight hours a day in the operating room, as she somehow fits two normal workweeks into each seven-week stretch. This particular day, she arrived at the hospital at 5:45 a.m. and saw 20 patients before going into surgery at 7:30 a.m. If it’s a good day, she may be able to head home by 7 p.m.

“You can’t be lazy or slow about anything,” Beatty said between mouthfuls of Lean Cuisine. With another year of residency ahead of her before she’s eligible to become board certified in general surgery, “you’re always in a rush,” she said.

Beatty is one of 16 surgical residents working their way through the Iowa Health residency program, which this year has 87 physicians in various stages of post-medical school training at Iowa Methodist Medical Center, Iowa Lutheran Hospital and Blank Children’s Hospital. It’s arguably the most grueling on-the-job professional training to be found anywhere in Greater Des Moines.

It’s also one of the primary sources in the state for training new doctors. Each year about half the physicians completing the programs choose to stay and practice in Iowa.

“I’m very proud of that,” said Dr. Douglas Dorner, Iowa Health’s senior vice president for medical education and research. “I think that part of our mission is to provide physicians for Iowa. Last year, out of 32 graduates of our programs, 17 stayed in Iowa. So it’s greater than 50 percent, and that’s been a consistent pattern over the years.”

Medical residency programs throughout the country underwent significant changes two years ago, when the Accreditation Council for Graduate Medical Education issued new guidelines limiting residents’ workloads to no more than 80 hours a week, averaged over a month, with on-call duty limited to no more than every third night. One day off out of seven, for an average of four days off a month, also became required.

Adhering to the new rules hasn’t been difficult, Dorner said, but it has been somewhat of a balancing act.

“When you send someone home by fiat at a specified hour, rather than at the conclusion of an episode of care, what we have to ensure is that professionalism always takes precedence over any sort of work hours,” he said. “What we’re finding is that patient care as a result is becoming more team-oriented. I think patients and families need to understand that.

“Going back to my surgery training as a resident in the 1960s and 1970s, I was on call every other day and every other weekend for seven years. That clearly is no longer done, and I think it’s a change for the better.”

Beatty, who served on the internal Iowa Health committee that implemented the new work rules, said the new system seems to already be creating a different work attitude among new residents, compared with when she started the program. Giving people more time away from the hospital appears to be a good thing overall, she said. There are potential drawbacks, however.

“We don’t know if we’re going to be turning out surgeons who have less operating experience,” she said. “We believe the answer is, ‘Yeah, you’re cutting them out of the hospital, they’re missing cases.’ Will it be enough to make a difference? Not here. But in programs where they’re not operating as much, it’s going to be a problem.”

Dr. Michelle Danielson, a third-year pediatric resident and chief resident for that program, is accustomed to juggling her schedule. She and her husband have three children, the youngest of whom is 9 months.

“There are male residents who have children and a wife, but when they have that newborn baby, they’re typically not the ones getting out of bed every three hours during the night and then coming to work at 6:30 a.m.,” she said.

“Sometimes it is (harder with a family), but I think a lot of times it’s a benefit because having a family and kids keeps you grounded and you remember what’s important in life,” Danielson said. “And I have a very nice support system. My husband has a wonderful job (as an Ankeny police officer), and there’s no way I would be where I am without his help.”

During the winter, the pediatric residents at Blank Children’s Hospital may admit as many as 18 sick children a day, “which is pretty overwhelming when you have three or four residents doing all that work,” she said. “And then to be on call every fourth night, and that you’re away from home, usually sleep-deprived. There are many nights when you’re up with the kids, or up on an hour-to-hour basis.”

The residency programs’ penchant for throwing residents into increasingly responsible roles can be unsettling at first, said Danielson, who now has oversight over each of her 17 colleagues as chief resident.

“As a medical student, you worked under a resident who was ultimately responsible,” she said. “You kind of have that safety net. Then, when you become a resident, all of a sudden, it’s July 1 and you’re on call and you’re the person the nurses are calling and asking the questions about the patient, and you’re expected to have the answer. It’s pretty overwhelming the first few months when you’re the physician and you’re the one who’s staying overnight with these sick kids.”

Each first-year resident can contact a senior resident who’s on-call for advice, and that resident has access to the faculty.

“But the overwhelming thought,” Danielson said, “is you hope you’re not going to have to call the attending physician at 2 in the morning because you’re not sure whether you can give them a pain medication; is it going to interact with something else or is it appropriate?

“You feel better by the end of the first year, but then in second year, you’re considered a senior resident in our program, and as a senior resident then you’re the one who oversees the intern those nights when you’re on call. So you go from being a nervous intern who has a senior resident to help you out, to the next year when you’re the senior resident whose intern is coming to you asking questions.”

A native Montanan, Danielson plans to join another pediatrician at a small clinic in Helena when she completes her residency this summer.

Beatty, a University of Iowa School of Medicine graduate who this month must decide between further schooling for a specialty or entering general surgical practice, said the prospect of someday working a 60-hour week is “a dream.” She said the ability to multi-task well has carried her through the past 12 years of medical school and post-graduate training.

“Having your pager go off three times while you’re scrubbed in the operating room, and by the way, you’ve got a consult in the ER, and you can only be in one place at one time, and you have to triage in your mind what the most important thing is, and you don’t even know what the most important thing is,” she said. “It’s very overwhelming to be thrown in and not know what the most important problem is.”

It wasn’t until she began her clinical rotations in medical school that Beatty, who had never thought about surgery as a specialty, realized it was her calling.

“Surgery was my first rotation, and I loved it,” she said. “And I thought it was just because I wasn’t in the classroom all day long. But my second rotation I didn’t love, and my third rotation I didn’t love. By Christmas time of my third year, I went home and said, ‘Holy crap, I want to be a surgeon! What am I going to do, how am I going to make it work?’” she said with a laugh. “I’m crazy.”

Iowa Health’s surgical residency program, which accepts only three new residents each year, is a tight-knit group that Beatty said has had zero attrition since she’s been there.

“That is not anywhere close to the national average for general surgery, which is about 20 percent,” she said. “That speaks to the quality of our staff surgeons.”

Another advantage of having a small program is the ability to be selective in who is recruited, Beatty said. Working together 80 hours a week, it’s crucial that everyone gets along.

“The ability to be a team player, concientious and hard-working might trump a perfect board score,” she said. “We have very high-quality people coming here, with excellent scores, but when it comes right down to it, if you’re not the kind of person that can fit in our system, it’s not going to work for anybody.”

dentons brweb 090123 300x250