My USA Today column on resident work hours

My latest USA Today column is now online and will be in Wednesday’s paper: Shorter doctor-trainee hours alone not solution.

My USA Today column on resident work hours I discuss the controversy surrounding limiting resident work hours, and explain why simply instituting a hard 80-hour weekly cap, along with mandatory naps, may not be the answer.

There’s little question that tired doctors make more mistakes, but the medical errors introduced from more frequent patient handoffs may negate the potential benefits of restricting physician work:

Nuance is required to prevent the unintended consequences of work restrictions. Rather than forcing doctors to nap or go home at a defined time, flexibility is needed so physicians can temporarily stay during medical emergencies. And patient handoffs need to be mandatory education for residents and interns, so they learn the importance of properly exchanging patient information.

Enjoy the piece.

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  • Jill of All Trades, MD

    I can tell you that the 80 hour work week “cap” is not even a cap in reality — many if not most residencies break this rule still, and residents don’t complaint or report their residencies in fear of being outcasted. Will be looking forward to reading your article :)

  • Jaci

    We restricted junior doctors hours here in the UK to 48 hours a week. Most of them do breach it but a shift system was introduced which has been proven by doctors organisations and Royal Colleges not just to be bad for patients, (poor handover) and trainees (less time in theatres clinics) but actually makes them more tired! The solution to such restirctions often end up creating more problems. While the original legislation called here the “European” Working Time Directive (it;s been UK legislation since 2002, how long before you drop the adjective!) is not as bad as the Depatment of Health’s NEW DEAL legislation which is completely inflexible expecially on breaks.
    Be careful what you wish for USA. Look at countries who have implemented these changes and are desperately struggling as a result.

  • d

    Why doesn’t anybody ever talk about the doctors’ health? Is it humane or healthy to keep somebody working 30 hours straight? I personally think that 70 hours a week and a maximum shift length of 24 hours would be a good balance. (normal 12 hour shifts, however) Residency is going to suck for me! (frown)

  • Frank Drackman

    Don’t wanta date myself, but in 1986 Surgery call was from 8am Friday until 8am Monday, you handled every thing surgical that came into the ER, appys, trauma, and a full days OR schedule Friday, and Monday,
    And Tuesday? another full day in the OR, and you were on call again until 8am Monday.
    OK, then you didn’t take call till Thursday, and you could go home early the next weekend, as long as none of your patients had to go back to the OR, which happened almost never.
    and that was just Internship, which is why I pass Gas now.

    Frank Drackman

  • Frank Drackman

    I meant to say you were on call again until 8am Wednesday, a simple mistake, and thats with 8 hrs of sleep…

  • dgh

    I don’t know why people never talk about the doctor’s health. It seems to be whenever someone wants to win are argument concerning doctors they just make it be “about the patient” as if the doctors are not human. Of the reasons that are given against work hours restrictions 2/3 rds are incredibly lame. Let’s look at what Kevin wrote:

    #1 More handoffs- So some study have shown that, in a culture that discourages hand-offs, when they increase more errors happen. All this means is that more time and training needs to be put into handoffs. You can train people how to do handoffs , you can’t “train” someone to not be sleep deprived.

    #2 Sure you need experience to become a master surgeon (the old 10,000 hours to master a skill rule), but how much of surgery is actually doing surgery. While it is important to followup with patients and to learn the skills such entails I’m guessing (I have no interest in surgery) that the residents do far more than their share of such tasks. Programs may have to change how they handle their resident training (unless of course you claim it isn’t training).

    #3 It’ll cost more money- Uhm so? Stop treating your residents like slaves. They are already unpaid and they will still be underpaid with the work hours restriction. This just makes no sense.

    The only thing I can figure out that it is like hazing. All the previous doctors went through it and by gone it they figure all the future doctors need to go through it with the declining health, absentee parents, and failed marriages that it brings. It’s too bad the government is on the side of the large corporations/hospitals and has decided that as a “training program” all of the workforce regulations and the right of collective bargaining our ancestors fought for don’t apply.

  • J

    The ship has long sailed on 80 hours, and our profession is going to have to learn how to better train young physicians to effectively hand off their patients. Hand-offs will continue to be a reality for the rest of our careers, since most of us don’t plan on being on call 24/7. Improving the hand off process is the solution, not asking residents to work longer hours.

    The key issue that I think you miss in your analysis (and the NEJM missed in its discussion) is that the $1.7 billion it would cost to institute the new IOM recommendations is a fair estimate of how much residents are currently underpaid. That residents are underpaid for their work is widely accepted. I think this article provides a number to begin the process of increasing resident compensation to something remotely fair.

  • madoc

    Atrocious inhumane treatment of resident slaves. Does this have anything to do with the future? Guess.

  • Dr. J

    I’d be interested in hearing your opinion on physician use of modafinil during long shifts? It’s now approved for use by shift workers, and Dr. Brian Goldman did a segment about ER Docs using it on his radio show (White Coat Black Art).
    I’m an ER Doc, I haven’t used it but I will admit that on the average night shift I drink 12+ cups of black coffee and maybe that is no different.
    In a world where long shifts are expected and mistakes are forbidden it’s not surprising to me that we are seeing use of psycho-stimulants in the medical profession…..I’m just not sure it’s a good answer…

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