Comments on: Poll: Is further reducing resident work hours worth the cost?

By: Anonymous

Anonymous — Fri, 31 Jul 2009 07:06:03 +0000

The current system of training medical graduates forces them to work long hours that ultimately deprives them of time with family, sleep and outside study time. Basically, as physicians, we’re hypocrites. We can tell patients to get plenty of sleep and eat right, keep a healthy balance between work and family in order to stay healthy mentally. We then turn around and ask residents to make medical decisions while incredibly sleep deprived (and yes, the amount of sleep deprivation depends on the program) which equates to making medical decisions while drunk (if driving sleepy is worse than driving drunk, then wouldn’t it be the same for making medical decisions?). We force residents to make a trade off between work and family–as a resident you have no choice in how much you work, and if you have a family then your family definitely suffers. As physicians how is it healthy and justifiable to subject young children to that kind of family life? As for the 80 hours a week leading to more learning from more patients, as it is there is no time to learn from your patients because you have only a very hurried didactic time during the day, and absolutely no chance to do outside reading. So, how am i learning? Instead of learning things from their fundamental cause on through to treatment, you learn things by rote memorization–look for these symptoms and treat with this drug. The why is not important because you have no time to find out–this is supposed to make me a good physician?
Additionally, with the demographics of medical school student changing to an older class with more women in it, there will be an absolute need for these students to be able to balance family life with work.
So what if residency time has to increase? A study done surveying the interest in part-time residencies showed a significant interest in one med school class, and there’s no doubt there would be the same interest among graduates of all med schools. I would gladly go to an internal medicine residency program that guaranteed no more than 60 hours per week but was a 4 year program, and there are many of my fellow residents that would do the same. The idea of being able to train and still have some kind of pseudo-balance in terms of family or social life is too great to resist. The primary care residencies in particular should be paying this idea more attention– as the interest in these residencies fall this would be a great way to make them desirable again.

By: Anonymous

Anonymous — Mon, 15 Jun 2009 05:37:03 +0000

I suggest that if residents are made to work 80 hours a week then the attendings should also stay in the hospital for 80 hours a week to supervise them (Because residents are not legally allowed to practice medicine independently). Doesn’t this sound fair? All in favor…
This resident work hour problem should solve by itself.

By: Paul

Paul — Sun, 14 Jun 2009 19:56:30 +0000

I graduated from Medical school in 1992. There were many times when internship and residency felt blatantly userous. Sometimes it reminded me of my college fraternity days and of “pledging” and “hell week”. I’m not sure what the answer is in terms of creating the better physician but I can tell you from experience that this issue, as do most, revolves around the almighty dollar. Shocker huh? Behave honorably, do what’s in your heart, be prepared and maximize your efforts in whatever system is there for you and you’ll do just fine.

By: 32 Papa

32 Papa — Sun, 14 Jun 2009 15:47:52 +0000

People assume that less hours is obviously better. As is pointed out, there’s very little to suggest this is true, at least as it applies to residents. The most cited study, which led to the adoption of the 80 hour week was deeply flawed. It was meant to be a direct comparison of different schedules for interns, and supposedly showed that the interns who worked less made less errors. What wasn’t accounted for was that the seniors on the ICU service ended up doing most of the work for the short hour interns, because the short hour interns didn’t know the patients as well…

By: sally

sally — Sat, 13 Jun 2009 02:23:58 +0000

Yes, the most time-saving and cost-saving practice is the continuity of care by the same physician;
otherwise twin tests are ordered, the re-assigned doctor will need time “again” for his own observations (b/c it is his license that is now on shift ;

By: William Hsu

William Hsu — Tue, 09 Jun 2009 04:40:37 +0000

I think you’re missing a key point: Transfer errors are correctable while fatigue just gets exponentially worse over time.

under the 100+ hour schedule you’re assuming a higher level of fatigue right off the bat.

If you’re trying to MAXIMIZE the quality of care to patients, the best way would be to focus on having physcially able residents working an adequate numbers of hours, and seemlessly switch off before quality of work fades.

The problem is we haven’t devised a way to reduce errors in communication.

By: Anonymous

Anonymous — Tue, 09 Jun 2009 01:54:10 +0000

Could they reduce the number of hours and at the same time decrease the salary of the residents, say to 40 hours/week and 1/2 the salary. I could then do some research/part time job for 20 hours and still end up with a similar salary.

By: John M. Grohol, PsyD

John M. Grohol, PsyD — Mon, 08 Jun 2009 23:08:58 +0000

Who wrote this post? Is this an advertisement?

Evidence is cited in the post, but no references given. How are we supposed to weigh the evidence without this basic attribute of evidence-based medicine?

Since the rate of new knowledge in medicine every year easily outpaces the average adult’s ability to keep up with it, would not this same rationale also work for current docs? I mean, if education and learning is so important, why shouldn’t doctors just continue working 80 or 100 hour work weeks for their entire career??

Lunacy parading as tradition. Appeals to emotion (with the constant mention of some hypothetical huge price tag) over logic.

Wow, medicine must be real special to turns its nose up at the significant body of existing research in the occupational sector (we’re talking *hundreds* of empirical studies) that show that skilled workers work more badly with lack of sleep and a disrespect for normal industrialized, civilized human working conditions (the upper limit being generally something between 50 to 60 hours a week).

More research? Bah. Look at something outside of your narrow field of medicine and you’ll see plenty of research about work hours and quality of work. What doctors do is not so special that this research doesn’t apply.

By: Frank Drackman

Frank Drackman — Mon, 08 Jun 2009 19:45:45 +0000

Strange that somehow they’re able to find the money to pay overtime for the RNs, RTs, Security, Housekeeping, every other Tom Dick and Harry, except for those slacker residents who only work 80 hours/week…

By: Aaron B. Hicks

Aaron B. Hicks — Mon, 08 Jun 2009 17:18:43 +0000

The fact that replacing residents with other health care workers would cost 1.6 billion dollars a year implies that residents are underpaid by that same amount. Cost-benefit analysis of reducing resident work hours aside, isn’t it just plain unfair to make residents work longer hours while paying them less than the market value of their services? If residents are so heavily relied upon, it seems obvious that they’re providing services at least as valuable as those provided by the other skilled health care workers who would theoretically have to fill the gap created by reduced resident work hours.