"So you work after you’ve been on call?"

I’ve noticed Kevin’s general take on this issue to emphasize that in the ‘real world’ there are no work restrictions. I don’t think this is the point though. I personally chose an internship that had a reduced call schedule and a night float system. I wanted to make my life easier and the process more enjoyable (or, at least, less painful).

We become residents and medical students so that we can learn – and the institutions that accept us are meant to do so, so that they can teach. All of this is much easier to accomplish if we get a decent amount of sleep (fostering consolidation of memories) and feel well-rested enough the next day to learn even better – both from books and from experiences. Certainly safety is another issue – for the patients who are taken care of by these residents. In my view, the professors and attendings in medical school and residency emphasized WHAT should be known – but were far less effective in creating an atmosphere and a proper balance of workload to foster the actual learning.

I think the unstated issues must be stated. Residencies are hard-pressed to survive, financially. They need residents, in reality, as a cheap work force, as people to take call for the academic attendings who can’t or won’t do so. Residents would probably learn much better with more limited hours, but residencies literally cannot afford to think in these terms.

All this having been said, I am against the government creating rules for how many hours residencies should have – it is simply none of their business. Perhaps abolishing the current stranglehold medical schools and residencies have on the system would free it up to more competition.

If you want a better system, allow ANY HOSPITAL to train residents and allow ANY PERSON to take proficiency exams. Potential residents would, in part, choose their programs according to how well the residents were treated (along with reputation, academic rigor, etc). If you feel the need to ‘control’ what doctors should know, then design your proficiency exams accordingly.