Resident Work Hours: The Solution

I don’t know why I didn’t think of it sooner. Or like many great ideas, why didn’t someone else come up with it? This morning at 4:30 as I lay awake having just received a consult from infernal medicine for an elderly lady being admitted with gallstones, atrial fibrillation and acute dehydration which could have waited until 7:00 a.m. today or even tomorrow, it hit me. I have the solution to the resident work hours controversy.

A few years ago, I was in the Navy and served on a ship. Crew members “stood watch” which consisted of a rotations of four hours on duty and eight hours off duty. Thus, each crew member worked eight hours per day but the work time was divided into two four hour shifts. To me this would be the perfect solution to the resident work hours dilemma.

I know, you are saying, “But Skeptical Scalpel, wouldn’t that mean six patient hand-offs per day?” Yes, of course it would. But according to the proponents of reduced work hours for residents, hand-offs are not a problem for continuity of care or patient safety. So if two or three hand-offs per day are OK, why not six?

There are a few issues that need to be worked out. For example, surgical residency training would have to be increased to 8 or 9 years duration. Operations would have to be scheduled carefully to enable a resident to participate from start to finish. All operations would have to last fewer than four hours. Each residency position currently filled by a single individual would require three people. Who is going to pay for that? Well, no one is concerned about who is going to pay for the newly adopted regulations limiting first-year trainees to 16 hour days. Then there are weekends, vacations and holidays which would mean that extra residents would be needed to cover.

Since I wrote this rather hurriedly, I may have overlooked something. I will give you 45 days to comment and then I will implement these new and improved work hours as stated.