Part of what makes this a hot button issue for me is that I trained before the institution of the work hours restrictions. Back in the old days, it didn’t matter how many patients I had or how much sleep I got overnight. I did my work and then went home. The bigger part is that I have seen the effects of work hour restrictions on residents and interns. They don’t see as many patients, and they don’t get follow up on their patients because they have to be out of the hospital by 10 am the next day. They come out of residence less well prepared to practice independently.
Over the past couple of years interns were no longer allowed to do the same 28 hour shift that residents do. They were limited to 16 hours, so on their admitting days, they did not spend the night in the hospital caring for the patients they admitted during the day. They hand off their patients to another intern who covers overnights, then they come in the next morning and pick up the patients they admitted the day before plus any that came in overnight. The residents go home, and the interns care for the patients with less resident supervision.
It became clear after a couple of years that interns were moving into their second year less well prepared to perform the duties of a senior resident, including taking overnight call after a full day of work. There were follow-through and learning issues as well. The Accreditation (Assassination) Council for Graduate Medical Education has rolled back the 16 hour restriction as a result.
This has been a frustration for me for 15 years or so. I absolutely understand the desire to be more humane and not have residents dangerously sleep deprived, making errors, and burning out. In my estimation, though, the 15 year experiment has failed. Patient outcomes are no different. Resident burnout is no different. Oddly enough, attending physician burnout is soaring. As an attending, I sometimes find myself doing things that a trainee ordinarily would do because there’s nobody else around to do it. Residents are not taking their abbreviated work day and making use of it catching up on sleep and reading. They go skiing post call. I’ve heard tale of people getting 40-50 days in during their intern year! I don’t think I had 40 days off as an intern.
Anyhow, I’m more than happy to discuss the issue here or by email. It’s something I’m passionate about, and more than anything else, this is what has driven me towards this master’s program. Residents are not learning what they need to know, so they need supplemental curriculum. Enter . . . . . .me.
Jim Lavelle, MD 