Resident work-hour limits still a struggle one year into restrictions
Meeting the work hour requirements challenges many residents. The penalty for non-compliance is so draconian, that few residents will report problems.
As I have posted previously, the problem with these rules is that they lack flexibility and common sense. We should strive towards an 80 hour workweek, and giving days off each month. However, residents feel that their education is compromised by the 24 + 6 rule.
What I cannot understand is how we are supposed to reconcile these rules with the increased emphasis on professionalism? As I understand professionalism, we as physicians have a responsibility to our patients first. The current work hour policy does not seem to take that into consideration. My interns and residents show high professionalism, but they sometimes they do work a bit later than the regulations specify. They do not tell me, nor anyone else.
These actions are not a display of machismo, but rather a sense of doing what is right. In their mind patient care comes first. I cannot argue with that feeling.
I worry that we are compromising their education with artificial rules. I understand that the rules are meant to counter abuses in the old system. However, no one understands the unintended consequences of these rules.
Those most affected by the rules, the residents, think the rules assinine. They understand that some months you work harder, and some months you work less hard. Residents always have had the option of choosing less strenuous programs, yet few of them did. We physicians want to do our best, as students, as residents and as practicing physicians. If that requires hard work, so be it.
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4 Responses to Resident work hours
Steve White, M.D.
July 19th, 2004 at 9:29 pm
As a fellowship director, I share your concerns. However, we should understand who these rules really were aimed at: the surgical residencies and sub-specialties, where work-weeks of 110 hours were not uncommon. The surgical residency where I was a medicine resident had a saying: “If you’re married when you arrive, and still married when you leave, you didn’t work hard enough.” They believed it.
Sensible docs and residents understand the need to balance hours and professionalism. We have these rules because some of our colleagues weren’t sensible.
poormedicalstudent
July 22nd, 2004 at 10:30 pm
you can see the effects of the rule change as more and more general surgery residencies start filling back up past the 65% match mark.
jeff
July 25th, 2004 at 6:25 pm
Ironically the new rule that limits work hours is probbably *costing* lives, rather than saving them (as it was designed to do). Now everyone is covering everyone else (because the resident is forced to go home early). Thus everyone’s running around with sign-out lists and no one really knows the patients. They just put out fires but there is less continuity and lots of stuff falls through the cracks. Of course this inevitable increase in morbidity is under the radar and thus will never be recognized.
bjb
March 13th, 2005 at 8:39 pm
I am a pgy 2 resident. I don’t think my education is being compromised by the shortened work rules at all. The on call guy signs out his patients to me post call so now I get to take care of 2x as many patients as before, ergo more patients and more education, not less.