A view from Mexico: Reforming resident work hours

Mexican medical residents have been submerged in a bygone system for decades. More than 100 work hours a week, scanty pay and psychological warfare are the everyday burden for residents in our country. You can read more about the working conditions of Mexican residents in my guest post, “The life of a medical resident in Mexico.”

Gradual progress is being made thanks to 30 years of pushing towards a reform. Our lawmakers have a better understanding of our broken education and training system for residents. Social networks and digital tools have done their part as well, helping us to organize ourselves and raise our voices.

Mexican health authorities have recently released the “Act for medical residency organization and functioning.”  These new reform mandates the regulation of the resident’s work hours. A limit of three nights on call a week has been established. This may still sound preposterous in some countries, but it’s a huge leap forward in medical education. This newly set verge will help to improve our resident’s quality of life and training.

A common practice among physicians in training in our country is to punish faults with extra work hours. In some programs, a simple wrong answer during rounds or a missing progress note can mean spending an extra night working or more. “Discipline shifts” are now forbidden in the new health legislation. Hopefully, thousands of residents will now work and learn without the fear of being held captive in the hospital.

Legal protection and counseling against lawsuits is now a right of every medical resident. The new Act requires for all resident training institutions to provide the necessary judicial support when needed. Educational liability is another concept strongly enforced in the recent piece of legislation. The institutions responsible for the resident’s training and education are for the first time ever compelled to provide adequate infrastructure and quality academics. Professors and attending physicians will have to attend certification courses in order to continue in contact with residents.

This newly taken step is the beginning of a process that started 20 years ago in most developed countries. The main obstacle to fulfill this nationwide task will be narrow-minded physicians and medical scholars in denial of a substantial change. Lack of resources will also block any advance in certain training centers. Nonetheless it will be the federal government’s duty to ensure a fair and sufficient distribution of the health budget.  As residents in an evolving system we must remain vigilant and critic to assure our well-being and proper education. Gradually, hospitals, universities and institutions across Mexico will have to adopt this new way of training their residents.  Many remain skeptic that this Act will bring any real and solid benefits for Mexican residents.  However, it will be our responsibility as residents to demand that this vicissitude is undertaken entirely and to seek counsel if it’s being ignored.

Cesar Lucio is a pediatrics resident in Mexico who blogs at SINESTETOSCOPIO.

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  • http://twitter.com/DilettanteMD Ernesto

    Cool post. Since I’m being trained in Mexico, and myself an aspiring medical resident this year I have necessarily to point out some issues. This so-called “reform” has been a small gossip in the halls of every hospital. Everybody talks about this new right as a physician in training whenever we feel threatened by discipline shifts but, if you’ve been training in this wild Mexico, you know the story is another. Though some people claim discipline shifts are something of the past, you didn’t count with the cleverness of the mexican people. They simply change the name from discipline shifts to extra learning hours… Mmmmm, quite witty.

    Residents are not the only medical trainees who suffer from this anachronic way of training. Interns are the ones that suffer the most!! no wage, no academics in most places, hardcore burn-out shifts, drawing a lot of blood -interns as scut monkeys- (a job for the nursing staff), a lack of respect from everybody in a hospital… Let’s be honest! This is the reality that the vast majority of hospitals face in Mexico. Even within the big hospitals of our country (Institutos Nacionales) this is something that still happens…

    I wouldn’t name close-minded to our health authorities. The proper name is ANACHRONIC health bureaucrats who aspire to be health authorities… These people from the top need to remember they were students, interns and residents too… It’s sad to look at the lack of empathy between their own fellows, comrades however you want to call them. They should grab one of the very basic human qualities: EMPATHY.

    I don’t see the panorama changing, this new Acta needs to involve a lot of other issues related to medical training in this country. Don’t forget SERVICIO SOCIAL (another anachronic phase of training in Mexico). Crimes committed within servicio social… Very sad stories.

    And if this change we’re looking for doesn’t happen while we’re still on training, DO CHANGE IT when we’re attendings, or chief residents, etc…

  • ninguem

    Is there a Board Certification system in Mexico, along the lines of the American College or the Royal College in the Commonwealth?

    • http://www.facebook.com/cesar.lucio1 César Lucio

      There is. Although there isn’t a certification for general practitioners, each particular College is entitled to certify the different specialists (Pediatricians, OBGyns, Surgeons, etc).

      • Guest

        The whole recertification process in Mexico is worthy of another blog post. Once you get certified, it’s really easy to be re-certified. You only need to attend the conferences the big pediatrics associations tell you and pay a fee. No more exams. No more formal or objective evaluations of your knowledge and competence. And of course, there may be one or two conflicts of interests there.

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