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Resident Work Hours Debate Continues

Many of you applauded the new Institute of Medicine report calling for stricter limits on resident work hours. Now, professional neurosurgery organizations have come out against the report, arguing that it does not address issues of patient safety or continuity of care. (Read more about that here.) What do you think? Join in the discussion below.

Christine Wiebe, Editor, Medscape Medical Students

December 15, 2008 in Webmaster | Permalink

Comments

Sour grapes! We all work long and hard enough with minimal compensation. I think these program directors are uspet that their supply of "cheap slave labor" is coming to an end.

Posted by: A Student | Dec 16, 2008 2:09:23 PM

If we continue to reduce the opportunities when we are to learn how to treat/manage those things which threaten the health of other human beings, when are we going to learn to do it? The more you work, the more you learn, the more succor you can provide.

Would you rather your child/wife/husband/mom/dad etc be treated by a physician who worked 100 hours a week for three years as a resident or 80 hours a week for three years? According to Osler, medicine is learned at the bedside. And if the amount of time we spend at the bedside is reduced, I believe our command of medicine is reduced as well. Reducing the hours will have a real impact on how we do our job.

Posted by: student2 | Dec 16, 2008 2:31:13 PM

If you have done a surgery rotation (including OB/GYN), I am sure you have experienced the yelling and sometimes actions that makes you question on how sometimes the most intelligent individuals can behave like children. Answers I get from most people for such behavior is "oh, they are really stressed out, the long hours etc". Well in truth there is a learning threshold, ex. if you do 30 C-Sections do you think you can do a C-Section on your own? So as long as the amount of procedures you do can be standardized to an amount, then that's it. The crazy hours ties in to "SLAVE LABOR". And the way we have to deal with billing and the con jobs of most insurance companies dictating doctor salaries, I am for less hours.

Posted by: Alpha | Dec 16, 2008 3:26:35 PM

As a non-surgical resident, I still feel the hours crunch. But the issue of continuity of care is not a new argument, and was the main camp's counterargument to the first hours cut. But it was needed. And we still have way too many medical errors, and long work hours are a part of the problem, though not all of it.

I think (again as an outsider, but I did go to med school after all) that the issue with #hours of training is that the system is quite inefficient. How many surgical interns do you know that do a single procedure. Or even R2's? It's limited. Much of the scut should frankly be passed to mid-level provider's, freeing the surgeons to learn the complex skilled procedures they want and need to learn. Therefore maximizing the hours they do have. How long does post-op management really take to learn at the level that most surgeons do it? Sadly not very long. I've seen plenty of private hospitals where surgeons do the surgery then the medicine residents do the post-op management (because there's no surgical residents there). Think about it.

Posted by: Resident, non-surgical | Dec 16, 2008 4:15:47 PM


I'm doing a gen surg intern year now and feel very mixed on this argument. I can't imagine working 120 hrs a week as interns did in the past. If surgery still did that I would not be in it. The 80 hour work week changes things. Also, after 24 hrs (maybe 16 :o), I don't learn much. Seriously, I'm like a robot going through the motions trying to finish so I can go home. If I slow down...if I stop to think, I fall asleep in a chair, at a desk, etc. I fall asleep at stop lights on my way home after a 30 hr shift.

More restrictions though?

I hate the idea of some small group dictating rules for everyone. Also, I feel that we get what we work for. I don't want some pushover system where we are restricted to banker hours because I think we will loose the blessings that go along with the current title of doctor. Patients know we have to sacrifice and it accordingly breeds trust and respect. A medical student from France rotated on my team here in the States. They have a very laid back training system it seems in France. If they stay for the afternoon the hospital has to provide food for them! Scrub nurses don't respect surgeons in the same way they do in the states. In her experience, they just walk out of the OR between 4 and 5. Surgeons can't operate late even if they want to. Is her experience skewed? Maybe.

Respect is earned. I don't want to limit the barriers to medicine too much. I want to be able to look back and see how medicine has stretched me into something I couldn't have ever been without the challenge. It was my choice after all. Where's the balance?

Thanks,
Clint

Posted by: Clint | Dec 16, 2008 6:00:13 PM

Your slave labor whining is BS. You should have known what you were getting into before you applied to med school. Sorry. I don't feel bad for you. And, if you are under the misguided belief that your residency will take the same amount of years with lowered hours, then you are as dumb as you are whiny. I rather work for the low salary for five years than seven.

Posted by: Mike | Dec 16, 2008 6:43:58 PM

This might be anonymous and venting is fun, but let's respect each others thoughts.

Thanks,
Clint

Posted by: Clint | Dec 16, 2008 8:15:37 PM

As a med student who considered surgery and is willing and able to work hard for long hours, I have mixed feelings. Personally, in general, working too many hours is like working drunk. Studies have shown this over and over again with reflex times and decision-making. Would we want doctors working drunk--even for the sake of "learning" or "continuity of care"? I think not. HOWEVER--I believe that there is certainly a bell curve when it comes to performance, and feel that if neurourgeons/general surgeons/others protesting the rules can take reflex time/reaction time/decision-making skills tests and prove to the rest of us that they are in the "top part of the curve" and are not performing as if drunk, than, by all means, let them work until they do become dangerous to patients. Bu how do you enforce that? Sleep-deprivation exams for surgical specialties? Maybe...

Posted by: Isha | Dec 16, 2008 8:39:45 PM

I think most people who go into a career of medicine are aware of the long hours and hard work needed. The public is still not quite aware of this, and may be shocked at the working conditions of doctors.

But some of these schedules are necessary. We need doctors to do call, people can get sick at any time.

There needs to be adequate hours for training purposes. We learn by doing, if we restrict the hours, how are physicians going to be trained and competent?

Posted by: medaholic | Dec 16, 2008 9:45:15 PM

I'm going to have to agree with Mike up there. I think of the number of Trust fund babies with parent physicians who have never worked an honest day in their lives, and i recognize them as the ones leading the "we don't make enough money" and "we work too long" groups and suddenly I wish that we had to work more just to spite them.

Posted by: Mike Hawk | Dec 16, 2008 10:34:25 PM

When my girlfriend was choosing a specialty, every single surgeon she talked to told her that if she was interested in surgery and something else, to do the other thing. The consistent message was that the hours demanded by the surgery residence will destroy your personal life.

As for the counterargument that there is no way to learn as much in 40 hours as you can in 100 hours, I can offer one very simple suggestion. It's called "education". From what I've seen from two institutions with great reputations (UW & UCSF), the specialties that overwork their residents the most also teach the least. When everyone is overworked, education completely disappears as a priority. Instead of treating residents as sweatshop labor, if they were to be treated as students they could learn more efficiently.

Medical education in this country is as screwed up as the rest of the medical industry. Very few people try to change any of it, and many entrenched stakeholders fight hard against change.

Posted by: Ted Howard | Dec 17, 2008 10:20:01 AM

Continuity of Care comes from the attending following the case, no matter what the specialty. Passing a case from one resident to another should not sacrifice patient care if the managing attending is fully involved in the case. Let the entire team participate, learn an let the patient care continue to be the best possible.

Posted by: Student | Dec 17, 2008 10:34:22 AM

well i too have mixed feeling about it.And yea some one on top pointed "---Would you rather your child/wife/husband/mom/dad etc be treated by a physician who worked 100 hours a week for three years as a resident or 80 hours a week for three years?---" its not the matter of hours its matter of time and your mind..working 100 hrs doesn't make a good doctor all it takes it dedication towards it and some free time to think about himself and his career.

Posted by: deepak | Dec 18, 2008 2:38:58 AM

well, with more hours of work, quality will deteriorate,,,,,,, so it is upto authorities to decide, what do they want???????????

Posted by: viral | Dec 18, 2008 4:51:11 AM

Medical education is not just about quantity, it's also about quality.

The only way to balance patient continuity, resident hours is using a night float system.

Posted by: Tim | Dec 18, 2008 9:29:08 PM

Clint, duuuuude, admit it -you're in it for the glory and the money......your post stank with it
VR

Posted by: V.Redux | Dec 26, 2008 6:46:53 PM

I realize that I'm late to this conversation. I think residency should start AFTER second year med school. If we learn by doing...why NOT start then? The subject of hours is covered...right?

Posted by: msearthtonez | Mar 16, 2009 12:14:04 PM

There is also the risk that by the time you get to be a doctor, you are sick yourself. Surely in 5 years of dealing with the sick people for a low income, you will find great comfort in your own home, and your expenses will increase exponentially. But i would still take the shorter way.

Posted by: Acnezine | Apr 13, 2009 2:37:12 PM

Residents do work long hours and I think it is necessary for them to be trained properly, and being able to deal with the high stress job of being a doctor.

Posted by: Physician disability insurance | Apr 21, 2009 11:37:03 AM

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