General Question

Flavio's avatar

Have you heard of the new proposed work hours rules for medical residents? If so, any opinions?

Asked by Flavio (1109points) July 11th, 2010

Medical residents are MDs or DOs who have completed medical school, but are in the process of completing a medical residency and preparing to sit for the specialty board exams. Residents are physicians in the process of becoming duly licenses. They provide the vast majority of care in the nation’s premier hospitals and trauma centers and are at the front lines of caring for thousands of inner-city patients.

Currently, the ACGME, the licensing body for residency programs, stipulates that residents cannot work for longer than 80 hours per week, averaged over 4 weeks; they cannot work longer than 30 hours per shift (and cannot see new patients in the last 6 hours of a 30 hours shift).

Fatigue is a major problem that leads to a lot of errors that may lead to adverse patient events. More information on that can be found here: http://www.hourswatch.org/.

The Institute of Medicine released in 2008 proposed reforms for resident duty hours. These can be found here: http://www.iom.edu/~/media/Files/Report%20Files/2008/Resident-Duty-Hours/one%20pager%20revised%20for%20web.pdf

From these, the ACGME released a very watered down reform proposal that is currently open to public comment http://acgme-2010standards.org/

Of course, for hospitals to fully implement the IOM report, there may be a considerable additional cost to cover some of the hours previously covered by greatly overworked residents. Hospitals are generally opposed to these reforms.

I am curious if anyone on Fluther has experience with this topic, encountered fatigued doctors, or has any opinions on this very intense debate in medicine.

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13 Answers

JLeslie's avatar

I think a doctor severely deprived of sleep is scary. So, my gut reaction is the change would be a good thing. Although, some of the arguments given in favor of keeping the long hours according to your links sound valid. A major deterrent from going into medicine for me was the idea of long hours while being a resident. You might notice I answer a lot of fluther medical questions, medicine and science have always interested me.

I hope some doctors answer your question, so we can see their opinion.

Response moderated (Unhelpful)
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Dr_Lawrence's avatar

The tradition of extended periods of clinical service without adequate rest seems to represent a hazing ritual, rather than a strategy to train physicians to provide a high standard of care. The resistance to change is not dissimilar to senior Fraternity members insisting that new members endure the same abuse to which they were previously subject.

The research on the adverse effects of sleep deprivation on cognitive functioning, perceptual impairment and the ability to function under stressful situations in neither new not controversial

Impaired physicians perform poorly and endanger patient care. The cost of liability insurance is related to the risk of medical errors that affect the health and risk the lives of patients. Sane scheduling practices should reduce high professional liability insurance costs.

Since residency is an educational process, allowing residents to get adequate rest leads to better learning and produces better doctors.

Arguing that bad practices that endanger patients, abuse residents and interfere with learning are necessary to control costs is unacceptable.

The profit motive does not justify bad administrative practices.

Response moderated (Off-Topic)
JLeslie's avatar

@Dr_Lawrence Interesting that you spoke of it as a hazing process. I had started to write, but then deleted it, because I was afariad it might lead the thread of track, that since the process is so physically demanding to become a doctor, that possibly doctors, especially young doctors, have less understanding of what it is like to be very ill, especially chroncally ill or in chronic pain. Because people who suffer from such illnesses probably would not consider going through the rigors of residency.

@Flavio I noticed one of the argumens against changing the hours was that some doctors prefer to be able to work long hours to get time off. Not sure what I think abou that, but it makes me wonder if some residency programs have an option for scheduling? Depending on what the resident prefers.

Andreas's avatar

@Flavio I’ve never understood why leading health providers (hospitals, in this case) would not insist on essential rest and nutrition to be a standard for the general community to follow. It’s simply commonsense that work is balanced with rest, recreation and proper nutrition. The only thought I come up with is that the powers that be don’t want us healthy at all, and hospitals and others lead the charge in achieving ill-health and attendant problems.

syz's avatar

I’ve always thought it an incredibly stupid idea to put patient care in the hands of sleep deprived, fatigued individuals. That’s not training, that’s Russian Roulette.

jerv's avatar

Given that deprivation has about the same effect as drinking a few beers (18 hours equals a BAC of 0.05 or more as far as reaction and cognitive skills go), I feel that the shorter hours make us all safer and will also bring down healthcare costs since there will be fewer mistakes made which will in turn bring down the cost of malpractice insurance (if the insurance companies pay out less, they can lower premiums).

@syz I was thinking Polish Roulette.

JLeslie's avatar

I just want to clarify…are the residents awake the entire time? I would assume not? Aren’t they just available all of that time, kind of on call in the hospital? I guess very busy hospitals there is no break though. Not sure how that works.

Rarebear's avatar

@JLeslie No, generally not.

jerv's avatar

@Rarebear @JLeslie It works about like a duty day does in the Navy; you may get a chance to sleep, but you might not, depending on how the night goes.

Jeruba's avatar

With respect to a hazing ritual before gaining entry to a profession, my son said the same thing about the California bar exam.

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