Do residents work too many hours?

OB/GYN News,  March 15, 2000  

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Do residents work too many hours?

YES It is simply not human to be able to function adequately while working sometimes 40 or more continuous hours on call.

The length of the American work week is generally considered to be 40 hours. It is not only abnormal, it is nonsensical to work those 40 hours without a break and many more hours after those. This is especially true when asking residents to make appropriate judgments under situations of sleep deprivation. Patient care can only be compromised in this situation.

During my residency, I experienced a lot of on-call situations in which my lack of sleep impaired my performance. More than once I took a phone call in the middle of the night, was told that a new patient had been admitted, and then began to doze off after I hung up. I know of other residents who have fallen asleep while examining patients.

A good solution would be a uniform policy on length of call that reflects a regard for the health of patients and residents. For starters, I don't think anybody should work more than 16 hours continuously.

What I have in mind is a system in which people cover overnight from 11 p.m. to 8 a.m. and stay through the morning rounds with the care team. That would be good for patients from the aspect of continuity of care and good for the residents because they could discuss the plans for the patient, rather than just covering overnight and leaving in the morning.

I think that residents learn more when they are well rested. It is time to abandon the flawed philosophy that residents will learn what they have to know to be a good physician if we keep them in the hospital for as long as possible.

When I was a resident, my attending was not there at midnight or 3 a.m. to check my reflexes. If residents' medical management reflexes are not responding right, who's paying the price? The patients, their physicians, and all of us are.

Dr. Maher Roman is an internist with the Jerry L. Pettis Memorial Veterans Medical Center, Loma Linda, Calif.

NO The 80-hour maximum work week for house staff recommended by the Accreditation Council for Graduate Medical Education is a level that keeps house staff from being exploited as worker bees. The problem is, house staff can't walk away when they are integral to patient care. Professionalism rules.

In training to become a physician, the commitment is to patients and to learning, and residents should take as much time as necessary to. fulfill that duty on their own initiative, so long as judgment does not become impaired in the process.

No one can argue with the statement: "If I'm falling asleep and dead tired, I don't do well." The issue is not a matter of sleep versus awake, it's a matter of how you structure your time when you are awake. Some house officers I know work an 80-hour week, then go out and moonlight.

Other house officers work 40-50 hours a week, then go out and moonlight 20-30 hours a week. Others will work 40-50 hours a week and spend the other time with their families. Yet all types of residents may still fall asleep during patient care.

People differ in stamina. Probably the best thing would be to find out what each doctor's tolerance is and tailor the program to his or her individual needs. That's an admittedly impractical approach, but I'd love to be able to take it.

In part, young physicians are to blame for their situation because they drive themselves. They may say "The expectations are too high," but in reality they're creating and sustaining the expectations. They can work less time, take off at every opportunity, and probably cut down their hours, but most young physicians don't do that because they resist mediocrity. What they're seeking is some external thing to stop what are often self-imposed expectations.

Many Americans work much longer for much less than do young physicians. To feel victimized by one's choice of career is naive and reflects, perhaps, a lack of experience with the realities of workplaces outside one's own.

Dr. Faith Fitzgerald is a professor of internal medicine and assistant dean of student affairs at the University of California, Davis.

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