It seems inevitable that restricting resident work-hours will soon lead to longer residencies.
An excellent piece in Slate details the price patients will have to pay, as doctors receive less experience. If “the mistakes of drowsy doctors are merely replaced by the mistakes of ill-trained doctors,” then the recommendations would have served no purpose.
Another point is that all resident specialties are lumped under the same recommendation. Surgery for instance, requires long hours to become technically proficient. If for some reason an operation lasts past a resident’s 16-hour threshold, “residents may someday soon have to prepare themselves to halt an operation and announce that it’s nap time.” There needs to be flexibility to best suit a specialty’s individual needs.
Finally, are hospitals prepared to pay the price as residents, their main source of cheap labor, are mandated to go home and be replaced by costly attending physicians and mid-level providers?
The only way around the depreciation of medical training and a sensitivity towards resident fatigue will be increasing the number of training years.
Expect to see that proposal soon.
Related posts:
- Restricting resident work hours forces doctors to lie, and other unintended consequences of the 80-hour work week
- Restricting resident work hours leads to a shortage of surgeons
- How work-hour restrictions harms resident surgeon training
- Surgeons don’t receive enough training when resident work-hours are capped
- Poll: Are the Institute of Medicine’s recommended restrictions on residents’ work hours good for medicine?
- Poll: Is further reducing resident work hours worth the cost?
- Resident work hours: An alternative view
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Residencies should set their own hours, by mine certainly missed the mark. Residency was hell because of the inability to get enough sleep. Sleep research has revealed just how much more information is retained, of what you studied during the day, if you are well-rested when you learn it and if you sleep well afterwards. The increased hours has less to do with learning and more to do with the hierarchical structure and tradition of academic programs.
who are the bad guys? the program directors and department administrators who allowed residents to be hijacked to perform menial work instead of demanding the hospitals hire appropriately?
Looks like a lot of valuable lessons could be learned from other countries who’ve gone through this same issue. And a lot of the same tired arguments about how the American consumer couldn’t afford consumer goods if factory workers and children weren’t forced to work 18 hour days.
In other words, yes, it’s a change, and yes, it’s going to be painful at first. But that’s not a justification or reason for staying with the old broken system. Well, it’s a justification, but a very poor one.
Replaced by mid-levels? Just hold on a minute, if mid-levels can do the job, then the residents should be adequately experienced to do the work by Labor Day of the Intern year, since by then they have–not even counting the clinical experience in medical school, exceeded the requirements for Nurse Practitioners.
In fact, since several state legislatures have decreed NP’s qualified to practice primary care independently, it is a complete farce and abusive labor exploitation to require medical students who want to do primary care go through any kind of residency at all as they already have far more extensive basic and clinical education.
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