Tuesday, October 12, 2010

Medical Student Whining and Resident Work Hours

For those of you who may not have heard, the Accreditation Council for Graduate Medical Education [ACGME] recently approved further restrictions on the number of hours that residents can work. The rules take effect in July of 2011. While many appreciate the fact that the ACGME was forced to do something to at least appear to rein in what has been portrayed as draconian working conditions for trainees lest Congress or OSHA or the ACLU enact even more onerous rules, the ACGME changes were met with mixed responses. Directors of residency training programs were most upset about the rule that restricts first-year residents to a maximum of 16 consecutive hours worked followed by a minimum of 10 hours off.

Even the mathematically challenged can see that 16 + 10 = 26, which will make scheduling interesting since last time I checked [I love that cliché], a day consists of 24 hours. The new trainees also are mandated to receive more supervision. What is not spelled out is how these new doctors are to learn to work independently the following year when they will be less supervised and stay awake for 24 hours never having done it before. As a practicing surgeon, I am here to testify that after working a full day, I am often called to see patients in the middle of the night. So far, we don’t have a mandatory 10 hours off, although it wouldn’t shock me if that is on someone’s agenda. Also, someone will have to take care of the patients when the first-year residents go home after 16 hours. Who that will be and how they will be funded is not clear.

The American Medical Student Association [AMSA] Thinks the restrictions did not go far enough. "We're going to keep pushing" for stronger limits "because it involves both patient safety and our safety and well-being," Sonia Lazreg, the group's health justice fellow [Wow!*], told The Associated Press. "The fight for safer work hours is not over."

Never mind that the jury is still out regarding the effect of the current work hours restrictions on patient safety, whether more frequent “hand-offs” of patients leads to more errors in patient care than tired doctors, what the long-term impact of these restrictions will be and many other aspects of the issue.

To the AMSA I say, stop whining about work hours. Why did you apply to medical school if you didn’t want to work hard? No one said it was going to be easy. Don’t tell me you didn’t know that doctors work long hours. This reminds me of the type of complaining that people do when they buy a house near an airport and then bitch about the noise. So AMSA members, get over yourselves. If you don’t like it, go to law school.

*(Comment by Skeptical Scalpel, who has applied for a health justice fellowship)


Anonymous said...


AMSA is being used to advance the agenda of SEIU and they do not know what is about to unfold for them. As future interns, not being able to work a full 24 hour shift will make them persona non grata at most institutions. Not because we think they are "weak" for not working the 24 hour shift but practically because it is impossible to schedule. This will inevitably lead to marginalization of an entire class of residents. As a current PD I expect all of my affiliated sites to ask for PGY2 or higher residents when we discuss and sign our affiliation agreements for 2011.

AMSA will likely get what they are asking for in terms of duty hours and they with SEIU will claim victory. I wonder if they will still see this as a victory when Surgery prolongs training by 1-2 years or worse, reputable teaching institutions decide that financially the cost of resident education is too burdensome and it is cheaper and more efficient to man the ship with physician extenders.

Anonymous said...

I agree completely; As a PD, I am ashamed at our organizations and our young physicians. NO ONE will every enter private practice-THAT WOULD BE TOO MUCH WORK!!! ahhh!! When you work like a social worker, expect to be paid like one also!!! AMSA does not understand what they are asking. If we want SEIU to represent us, get ready to pay your dues, work less, and be treated like a GM employee. But what is even more scary, is picture a night in say 2025 and YOU have the perforated diverticulum, who will be operating? someone whose read about it, maybe seen 1 or 2 . . . put your life in there hands!! God help us all!!! They'll do a perfect handoff, though!! What are we doing???

Anonymous said...

This action by the ACGME will promote the single biggest patient safety risk than I have seen in 40 years of surgical care. The most frightening aspect is the insidious nature of the effect; it will take several years to realize the debacle that has been inadvertantly created. The 2nd most frightening aspect is the indifference by most of the surgical community.

Anonymous said...

Got data? There's plenty of whining on every side of this, but precious little actual information about outcomes. Libby Zion did not die because an intern was tired.

Skeptical Scalpel said...

There area lot of papers documenting the lack of data regarding tired residents and outcomes. I am away from home now but can send you some references tomorrow or Monday if you like. Also, I agree with you about Libby Zion not dying because of tired residents. I blogged about this in July. See http://skepticalscalpel.blogspot.com/2010/08/medical-education-is-changing-in-bad.html

Dan said...

At least at my medical school, the AMSA, like the AMA for physicians, does not represent the consensus views of the students. These self-selecting members are definitely work less/ "how dare my superiors tell me what to do" kind of crowd. It's too bad there isn't a medical student organization representing the "dear God what are they doing to our education" side.

Anonymous said...

I see there has been a lack of discussion on this post for a while, but I'll just throw in my two cents. While doing my third and fourth year rotations over the past two years, I've been expected to take call with the PGY2s and have had numerous rotations on which I was able to do 30 hours shifts, still being expected to get work done as the shifts near their ends. Rotating in the MICU just recently, following the initiation of the 16 hour rule for interns, I was still doing 30+ hour shifts with the PGY2s and actually putting in more hours than any of the residents on the service. I didn't complain then and I'm not complaining now. I agree with what Dan said above--we're not all whiners

Skeptical Scalpel said...

It's good to hear. I hope you'll go into surgery.

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