In 2003 the Accreditation Council for Graduate Medical Education (ACGME), which accredits U.S. medical training programs, instituted rules for resident work hours. These have sometimes been referred to as the "the eighty-hour workweek" and limits residents' duty hours to no more than eighty hours a week.
These rules govern the working conditions of the 100,000 young doctors-in-training in teaching hospitals across the United States and were developed both to protect patients from potentially unsafe medical practices by sleep-deprived physicians and to improve working and learning conditions for residents.
But has it worked?
The work rules also limit both the number of consecutive days in a week and the number of consecutive hours in a shift that a physician-in-training can work and they require rest periods of at least ten hours between shifts.
Nobody wanted procedures or important decisions to be made by exhausted doctors, so the intent was to form medical teams that would work in rotating shifts, thus providing the physicians with adequate time off.
There have been some studies that suggest that compliance with the new work rules reduces wandering attention on the part of the residents and might reduce actual or near-miss car accidents, but there are other studies that are ambiguous about the outcomes of the rule changes.
Furthermore, the validity of the methods and analyses in these studies and the generalizability of the results are certainly open to discussion.
We do know with certainty that fragmentation of care increases cost, length of stays in the hospital and potentially medical errors.
The bottom line is that the total impact of the new rules on physician performance and learning, as well as on patient care and safety, remains largely unknown.
Besides ensuring excellent medical treatment for patients, the ACGME work rules were intended to keep residents alert so that they could fully engage in the work and education needed to become fine physicians.
The rules, however, are backfiring.
Residents no longer are able to observe the timing of a patient's response to an intervention; they can't follow the tempo of a fever or the bloom-and-fade cycles of a rash even when, as responsible physicians would, they sincerely want to.
As residents in training, their heads are crammed with the facts they've learned during medical school, but because of these new rules, they can't see firsthand the course of many disease processes or the recovery from a surgical procedure and then integrate those facts into informed decision making. This will limit their knowledge and experience when they enter private practice and have no backup in decision-making.
Instead of producing physicians with high professional standards who see their patients through to the end (of labor, of an operation, of an illness, of a life), the current system is creating a legion of shift-worker physicians who leave when the clock strikes a certain hour rather than when the job has been completed.
Autonomy is important in training programs and the residents realize that in the future they'll be solely responsible for the care of their patients. Many worry that without a certain amount of autonomy during their training; they won't be adequately prepared for independent decision making.
Lengthening the training program just adds more cost and more debt which is already a burden to many of the residents.
In addition, statistics show that new physicians entering the workforce are about 20% less productive than those physicians they are replacing leading to a greater need in getting physicians working.
Labels: resident, traininig
