We learn how to care for our patients properly and efficiently in residency. While I do not agree that residents should routinely work 36 hour shifts on a continuous basis, I would be in favor of placing time constraints that can more closely resemble what we can expect to see in our private practice.
The recent change to the final rule regarding resident work hours went into effect on July 1 for residents in graduate medical education programs in the United States.
The new regulation states that physicians in their internship or first year of residency training cannot work a shift of more than 16 hours duration. Upper level residents in their second year and beyond cannot work a shift of more than 28 hours duration without rest. While I understand the premise behind the hours limit for residents in training, I must confess that I would be concerned that such regulation will place undue burdens on training programs and hospitals that are already short staffed.
My residency training program in the southeast found me in training from 2000 until 2003. During that time, my first two years of training found me spending a great deal of time at the hospital and in the family medicine clinics. I cannot honestly say that my training program was harsh or malignant, as we had 12 residents in each class and having such a high number allowed for my call schedule on most rotations to be 1:3 or 1:4 for most of my first year. Our attendings were very aware of each resident's performance and any concerns regarding our decision making abilities were addressed through continuous reviews. My second year of residency found my call schedule to be 1:4 for most rotations and by that time I was able to serve as an upper level resident to watch after the interns. The third year call schedule was more relaxed and each resident had a 1:12 call rotation and again such rotations placed us in a supervisory level for monitoring the first and second years.
Water cooler discussions these days find older physicians being very harsh and overly critical of the relaxed time constraints for new residents. While my program was able to balance a rigorous call schedule with time allowed for proper rest in between call duties, most other programs did not provide such a luxury. The main concern from senior physicians regarding the new time constraints in training pose the question that everyone is asking: Will the new residents in training be ready for their private practice duties after finishing residency training?
There are several studies that demonstrate time constraints do not place in jeopardy the learning process during residency. Such proponents of the new rule state that even though the number of patient handoffs is higher, the benefits of allowing proper rest promote better decision making and thus result in shorter length of stays in the hospital. Such shorter lengths of stay result in lowered costs for the parent hospital and the training program. In my humble opinion, I feel that the quality of patient care decreases with each physician handoff.
During my time in residency training, I can honestly say that I was never fatigued to the point of not being able to think clearly. The times that found my workload to be overwhelming allowed for my supervising resident or attending to come and provide assistance when needed. Further, I am thankful for the fact that there were no duty hours restrictions placed on my program during my training years. I am especially thankful for this fact during the times that I find myself in the hospital caring for my patients well after my office has closed. I feel that I was trained appropriately and adequately.
We learn how to care for our patients properly and efficiently in residency. While I do not agree that residents should routinely work 36 hour shifts on a continuous basis, I would be in favor of placing time constraints that can more closely resemble what we can expect to see in our private practice. At present, since I have only been in private practice for eight years, I still routinely work 11-13 hour days. Comparing this to my years in residency training makes private practice feel like a walk in the park. We will not be able to see the successes or failures of the new rule for several years to come, however rather than to continuously decrease the number of hours worked per day, I would be more in favor of returning to the traditional hours but allow for an adequate amount of time for appropriate rest (at least three days) in between call nights. Some will agree and some will oppose, however the new rule is here and there is no doubt that it will be here to stay.
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