RangelMD.com featured this article yesterday - Surgery residents' long hours draw warning for Yale. We all understand that 120 hours a week is too much. I believe that some night call is necessary. What is the right proportion? Internal medicine seems to lead in such reforms. Our residents have 4 days each month of no work. They cannot come to the hospital on those days - even if they want to come.

They work every 4th night and we limit both the number of admissions and the total workload. If we assume that most days average 10 hours (just averaging), and most days post-call they can leave by around 6 p.m. (giving a 34 hour shift which sometimes includes sleep), then they have approximately 84 hours per week or less (figuring 2 call days, 4 regular days and 1 off day). This is generally an overestimate of their workload, since they leave earlier than 6 p.m. many days - and we encourage that.

Is that a reasonable work load? How do we define reasonable? I'm comfortable with this configuration, and our housestaff seem happy.

To decrease hours at this point would require a night float system. While many programs use such a system, our housestaff consistently reject implementing a night float. I do believe that we have a humane program. The days off really work. This month one intern had a 2 day vacation last weekend, the other has a 2 day vacation this weekend. Nothing like a mini-vacation to boost the spirits.

Apparently, we (medical school faculty) must proactively fix this situation. Some schools have done a good job. Paying attention to these details has helped our recruitment of housestaff. Maybe Yale will finally "get it". I hope all surgery programs start to get it.

What is the downside of hours? We did a small study several years ago and found out that one night of sleep deprivation seemingly caused free floating anger. When I mention this to our housestaff, they always nod in agreement. My recollections confirm this finding. Does this explain some of the hostility we see in some residents?

I hope we can fix this without the courts. Whenever the courts get involved, we get collateral damage.